Provider Demographics
NPI:1578131686
Name:CUSTOMFIT360
Entity Type:Organization
Organization Name:CUSTOMFIT360
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:NASM-CES
Authorized Official - Phone:703-626-3157
Mailing Address - Street 1:6 OCEANWILLOW DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-2922
Mailing Address - Country:US
Mailing Address - Phone:703-626-3157
Mailing Address - Fax:
Practice Address - Street 1:29 ATLANTIC AVE STE K
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-9155
Practice Address - Country:US
Practice Address - Phone:302-581-2027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service