Provider Demographics
NPI:1881048122
Name:CROSSFIT 363 LLC
Entity type:Organization
Organization Name:CROSSFIT 363 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DASILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-734-7623
Mailing Address - Street 1:363 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3867
Mailing Address - Country:US
Mailing Address - Phone:214-734-7623
Mailing Address - Fax:972-436-3182
Practice Address - Street 1:363 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3867
Practice Address - Country:US
Practice Address - Phone:214-734-7623
Practice Address - Fax:972-436-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7121332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies