Provider Demographics
NPI:1063600583
Name:FITNESS QUEST-BOCA GRANDE LLC
Entity type:Organization
Organization Name:FITNESS QUEST-BOCA GRANDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARTRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-964-2300
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:941-964-2300
Mailing Address - Fax:941-964-2320
Practice Address - Street 1:280 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:BOCA GRANDE
Practice Address - State:FL
Practice Address - Zip Code:33921
Practice Address - Country:US
Practice Address - Phone:941-964-2300
Practice Address - Fax:941-964-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty