Healthcare Provider Details

I. General information

NPI: 1033129895
Provider Name (Legal Business Name): FITNESS QUEST - VENICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 TOWN CENTER PKWY
LAKEWOOD RANCH FL
34202-4175
US

IV. Provider business mailing address

3657 CORTEZ RD W STE 110
BRADENTON FL
34210-3171
US

V. Phone/Fax

Practice location:
  • Phone: 941-209-3922
  • Fax:
Mailing address:
  • Phone: 941-483-3400
  • Fax: 941-483-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT PORTER
Title or Position: CEO
Credential: PT
Phone: 941-356-6416