Provider Demographics
NPI:1902946379
Name:FIT QUEST THERAPY & REHABILITATION INC
Entity Type:Organization
Organization Name:FIT QUEST THERAPY & REHABILITATION INC
Other - Org Name:FITQUESTTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:801-668-3500
Mailing Address - Street 1:2120 N 400 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7238
Mailing Address - Country:US
Mailing Address - Phone:801-782-3500
Mailing Address - Fax:801-786-1926
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:84414-7238
Practice Address - Country:US
Practice Address - Phone:801-782-3500
Practice Address - Fax:801-786-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103041-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055599Medicare PIN
UT000057421Medicare ID - Type Unspecified
UT005580400Medicare ID - Type Unspecified
UT000055599Medicare ID - Type Unspecified
UT000055600Medicare ID - Type Unspecified