Healthcare Provider Details

I. General information

NPI: 1194599761
Provider Name (Legal Business Name): FIT TEMPLE 365 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W GREEN OAKS BLVD
ARLINGTON TX
76013-8350
US

IV. Provider business mailing address

204 CHATEAU AVE
KENNEDALE TX
76060-2108
US

V. Phone/Fax

Practice location:
  • Phone: 817-704-3365
  • Fax: 817-870-1784
Mailing address:
  • Phone: 217-520-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCO BRITTON
Title or Position: CEO/FOUNDER
Credential: MD, MPH
Phone: 817-376-7599