Provider Demographics
NPI:1356543482
Name:SRA MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:SRA MANAGEMENT GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FITNESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIKKINEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CSCS
Authorized Official - Phone:508-541-1400
Mailing Address - Street 1:800 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1271
Mailing Address - Country:US
Mailing Address - Phone:508-541-1400
Mailing Address - Fax:508-553-3014
Practice Address - Street 1:800 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1271
Practice Address - Country:US
Practice Address - Phone:508-541-1400
Practice Address - Fax:508-553-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty