Healthcare Provider Details

I. General information

NPI: 1215451471
Provider Name (Legal Business Name): FITNESS QUEST-ELLENTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 US HIGHWAY 301 N
PARRISH FL
34219-8669
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 941-721-9100
  • Fax: 866-721-4334
Mailing address:
  • Phone: 941-721-9100
  • Fax: 941-721-9119

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 BARTRUFF
Title or Position: OWNER
Credential:
Phone: 941-721-9100