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General NPI Number Information
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NPI Number | 1548343916
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Entity Type | Organization
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Legal Business Name | CUSTOMFIT PROLABS INC
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Dates
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Enumeration Date | 10/22/2006
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 8043 W MCNAB RD
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City | TAMARAC
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State | FL
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Zip | 33321-3254
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Country | US
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Telephone | 954-721-7301
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Fax | 954-721-7453
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Provider Business Mailing Address
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Address Line | 8043 W MCNAB RD
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City | TAMARAC
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State | FL
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Zip | 33321-3254
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Country | US
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Telephone | 954-721-7301
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Fax | 954-721-7453
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK THIGPEN
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Credential | LPED/CO/ORF
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Telephone | 954-721-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 335E00000X
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License Number State | FL
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