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General NPI Number Information
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NPI Number | 1336739119
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Entity Type | Organization
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Legal Business Name | FQ0015, LLC
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 9025 TOWN CENTER PKWY
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-4175
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Country | US
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Telephone | 941-209-3922
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Fax | 941-209-3912
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Provider Business Mailing Address
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Address Line | 3657 CORTEZ RD W STE 110
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City | BRADENTON
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State | FL
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Zip | 34210-3171
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Country | US
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Telephone | 941-209-3922
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Fax | 941-209-3912
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MACKENZIE BARTRUFF
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Credential |
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Telephone | 941-916-5702
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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 |
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License Number State |
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