Provider Demographics
NPI:1780248864
Name:CUSTOMFIT CONCIERGE MEDICINE, HEALTH AND FITNESS LLC
Entity type:Organization
Organization Name:CUSTOMFIT CONCIERGE MEDICINE, HEALTH AND FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:312-619-3556
Mailing Address - Street 1:1413 W FILLMORE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4716
Mailing Address - Country:US
Mailing Address - Phone:312-619-3556
Mailing Address - Fax:833-467-1276
Practice Address - Street 1:1413 W FILLMORE ST APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4716
Practice Address - Country:US
Practice Address - Phone:312-619-3556
Practice Address - Fax:833-467-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy