Functional Rehab & Fitness LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

4346 Issued in CT

Legal business name

FUNCTIONAL REHAB & FITNESS LLC

Practice address

350 Litchfield Rd
New Milford, CT 06776-2003

Phone

(860) 355-5373

Fax

(860) 355-8171

NPI assigned

Nov 27, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Gail Theresa Henderson, MS,ATC,PT,CCRPNPI 1083639280

Title

Owner

Phone

(860) 355-5373

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gail Theresa Henderson, MS,ATC,PT,CCRP

  • Physical Therapist
  • New Milford, CT
  • NPI 1083639280
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093881559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 LITCHFIELD RD",
            "city": "NEW MILFORD",
            "state": "CT",
            "postal_code": "067762003",
            "telephone_number": "860-355-5373",
            "fax_number": "860-355-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 LITCHFIELD RD",
            "city": "NEW MILFORD",
            "state": "CT",
            "postal_code": "067762003",
            "telephone_number": "860-355-5373",
            "fax_number": "860-355-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL REHAB & FITNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "THERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-355-5373",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS,ATC,PT,CCRP"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CT",
            "license": "4346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Anthony Fusco
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• Edmund Anthony Ganal, M.D.

• Physical Therapy Clinic/Center in New Milford, CT
• Providers in New Milford, CT by specialty
• Physical Therapy Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.