Provider Demographics
NPI:1528219631
Name:FITNESS QUEST - BRADENTON LLC
Entity Type:Organization
Organization Name:FITNESS QUEST - BRADENTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARTRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-474-2700
Mailing Address - Street 1:11045 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1072
Mailing Address - Country:US
Mailing Address - Phone:941-474-2700
Mailing Address - Fax:941-474-8081
Practice Address - Street 1:2828 S MCCALL RD
Practice Address - Street 2:UNIT 40
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-7791
Practice Address - Country:US
Practice Address - Phone:941-474-2700
Practice Address - Fax:941-474-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBN795AOtherMEDICARE PTAN