Provider Demographics
NPI:1033129895
Name:FITNESS QUEST - VENICE LLC
Entity type:Organization
Organization Name:FITNESS QUEST - VENICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-356-6416
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:941-483-3400
Mailing Address - Fax:941-483-3422
Practice Address - Street 1:9025 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-4175
Practice Address - Country:US
Practice Address - Phone:941-209-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY091MZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
FLK7808Medicare ID - Type UnspecifiedGROUP NUMBER