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General NPI Number Information
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NPI Number | 1093129181
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Entity Type | Organization
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Legal Business Name | EQUEST PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 506 4TH AVE W
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City | PALMETTO
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State | FL
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Zip | 34221-5203
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Country | US
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Telephone | 941-729-1800
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Fax | 941-722-7844
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Provider Business Mailing Address
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Address Line | 2722 MANATEE AVE W STE 2
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City | BRADENTON
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State | FL
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Zip | 34205-4945
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Country | US
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Telephone | 941-744-9046
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Fax | 941-567-4079
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Authorized Official
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Title or Position | OWNER
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Name | JOHN WALZ
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Credential | MS PT
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Telephone | 941-744-9046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT21392
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License Number State | FL
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