Provider Demographics
NPI:1457058802
Name:CLINICAL FITNESS 101 CORP
Entity Type:Organization
Organization Name:CLINICAL FITNESS 101 CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-247-0745
Mailing Address - Street 1:3344 GONDOLIER WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3622
Mailing Address - Country:US
Mailing Address - Phone:561-247-0745
Mailing Address - Fax:
Practice Address - Street 1:3344 GONDOLIER WAY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-3622
Practice Address - Country:US
Practice Address - Phone:561-247-0745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty