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General NPI Number Information
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NPI Number | 1962123166
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Entity Type | Organization
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Legal Business Name | CONQUER WELLNESS PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 10390 SANTA MONICA BLVD STE 220
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City | LOS ANGELES
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State | CA
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Zip | 90025-6960
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Country | US
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Telephone | 310-801-7746
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Fax |
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Provider Business Mailing Address
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Address Line | 325 N LARCHMONT BLVD # 231
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City | LOS ANGELES
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State | CA
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Zip | 90004-3011
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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 | PRESIDENT
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Name | AARON PARK
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Credential |
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Telephone | 310-801-7746
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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 |
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License Number State |
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