Provider Demographics
NPI:1043220817
Name:FITNESS QUEST - PUNTA GORDA LLC
Entity Type:Organization
Organization Name:FITNESS QUEST - PUNTA GORDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-575-7300
Mailing Address - Street 1:3657 CORTEZ RD W STE 110
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3171
Mailing Address - Country:US
Mailing Address - Phone:941-575-7300
Mailing Address - Fax:941-505-7301
Practice Address - Street 1:530 E OLYMPIA AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3838
Practice Address - Country:US
Practice Address - Phone:941-575-7300
Practice Address - Fax:941-505-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY053TZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
FLK6909Medicare ID - Type UnspecifiedGROUP NUMBER
FLY079QZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #