Healthcare Provider Details

I. General information

NPI: 1578131686
Provider Name (Legal Business Name): CUSTOMFIT360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ATLANTIC AVE STE K
OCEAN VIEW DE
19970-9155
US

IV. Provider business mailing address

6 OCEANWILLOW DR
OCEAN VIEW DE
19970-2922
US

V. Phone/Fax

Practice location:
  • Phone: 302-581-2027
  • Fax:
Mailing address:
  • Phone: 703-626-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIK J SCHREIBER
Title or Position: OWNER/OPERATOR
Credential: NASM-CES
Phone: 703-626-3157