Provider Demographics
NPI:1558511451
Name:FIT QUEST THERAPY AND REHABILITATION CLINIC, LLC
Entity Type:Organization
Organization Name:FIT QUEST THERAPY AND REHABILITATION CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:801-668-3500
Mailing Address - Street 1:3578 N 875 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-3242
Mailing Address - Country:US
Mailing Address - Phone:801-668-3500
Mailing Address - Fax:
Practice Address - Street 1:2120 N 400 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7214
Practice Address - Country:US
Practice Address - Phone:801-782-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty