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General NPI Number Information
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NPI Number | 1750777439
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Entity Type | Organization
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Legal Business Name | CONQUER PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 454 MAIN AVE
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City | NORWALK
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State | CT
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Zip | 06851-1063
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Country | US
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Telephone | 203-635-3187
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Fax |
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Provider Business Mailing Address
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Address Line | 454 MAIN AVE
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City | NORWALK
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State | CT
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Zip | 06851-1063
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | DANIELA V PURSLOW
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Credential |
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Telephone | 203-635-3187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 009820
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License Number State | CT
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