Healthcare Provider Details

I. General information

NPI: 1639257405
Provider Name (Legal Business Name): FITNESS QUEST - NORTH PORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 BOBCAT VILLAGE CENTER RD SUITE C
NORTH PORT FL
34288-8475
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 941-426-7400
  • Fax: 941-426-7044
Mailing address:
  • Phone: 941-426-7400
  • Fax: 941-426-7044

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: MRS. MACKENZIE M BARTRUFF
Title or Position: MANAGING MEMBER
Credential:
Phone: 941-426-7400