Provider Demographics
NPI:1225361074
Name:PHOENIX CONQUEST, LLC
Entity Type:Organization
Organization Name:PHOENIX CONQUEST, LLC
Other - Org Name:WATSON REHAB SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:412-302-1668
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-0844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 ADAMS POINTE BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-4667
Practice Address - Country:US
Practice Address - Phone:412-302-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy