Healthcare Provider Details

I. General information

NPI: 1104417831
Provider Name (Legal Business Name): THE EXQUISITE FIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20421 ROUTE 19 STE 105
CRANBERRY TOWNSHIP PA
16066-7514
US

IV. Provider business mailing address

20421 ROUTE 19 STE 105
CRANBERRY TOWNSHIP PA
16066-7514
US

V. Phone/Fax

Practice location:
  • Phone: 610-730-1158
  • Fax:
Mailing address:
  • Phone: 610-730-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL STUTZENBURG
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-730-1158