Organization · NPI-2

Fulcrum Performance Lab, LLC

Clinic/Center · Marlton, NJ

NPI number1205464823
StatusActive
Last updated in NPPESJul 17, 2020

Details

NPI
1205464823
Entity type
Organization (NPI-2)
Legal business name
Fulcrum Performance Lab, LLC
Organization subpart
No
Enumeration date
Mar 30, 2020
Certification date
Jul 17, 2020
Last updated
Jul 17, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

75 S Maple Ave
Marlton, NJ 08053-2032

Phone 856-607-2400

Mailing address

75 S Maple Ave
Marlton, NJ 08053-2032

Phone 856-607-2400

Authorized official

Charles Bruce Morris
Chairman / Ceo
6092845456

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