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General NPI Number Information
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NPI Number | 1780248864
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Entity Type | Organization
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Legal Business Name | CUSTOMFIT CONCIERGE MEDICINE, HEALTH AND FITNESS LLC
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 1413 W FILLMORE ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60607-4716
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Country | US
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Telephone | 312-619-3556
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Fax | 833-467-1276
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Provider Business Mailing Address
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Address Line | 1413 W FILLMORE ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60607-4716
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Country | US
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Telephone | 312-619-3556
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Fax | 833-467-1276
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY BITTER
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Credential | DPT
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Telephone | 312-619-3556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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