MEDICARE: FITNESS QUEST - NORTH PORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AB743	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1639257405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITNESS QUEST - NORTH PORT LLC

Provider Business Mailing Address
First Line	:	3657 CORTEZ RD W STE 110
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34210-3171
Country	:	US
Telephone Number	:	941-426-7400
Fax Number	:	941-426-7044

Provider Business Practice Location Address
First Line	:	2530 BOBCAT VILLAGE CENTER RD
Second Line	:	SUITE C
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8475
Country	:	US
Telephone Number	:	941-426-7400
Fax Number	:	941-426-7044

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MRS. MACKENZIE M BARTRUFF
Credential	:
Telephone Number	:	941-426-7400

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/09/2024

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Directions to “FITNESS QUEST - NORTH PORT LLC ” Practice Location

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