MEDICARE: FIT QUEST PHYSICAL THERAPY OF NORTH OGDEN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1366916470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIT QUEST PHYSICAL THERAPY OF NORTH OGDEN INC

Provider Business Mailing Address
First Line	:	1638 N WASHINGTON BLVD STE 103
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84404-3790
Country	:	US
Telephone Number	:	801-782-3500
Fax Number	:	801-786-1926

Provider Business Practice Location Address
First Line	:	1638 N WASHINGTON BLVD STE 103
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84404-3790
Country	:	US
Telephone Number	:	801-782-3500
Fax Number	:	801-786-1926

Authorized Official
Title or Position	:	OFFICER
Name	:	MONTE ZUNDEL
Credential	:	MPT
Telephone Number	:	801-782-3500

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	05/06/2020

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