Provider Demographics
NPI:1407554033
Name:CONQUER PHYSIO WELLNESS & TRAINING SYSTEMS, LLC
Entity Type:Organization
Organization Name:CONQUER PHYSIO WELLNESS & TRAINING SYSTEMS, LLC
Other - Org Name:CONQUER MOBILE THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMNTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERSHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:989-443-9365
Mailing Address - Street 1:14061 PACIFIC POINT PL APT 208
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14061 PACIFIC POINT PL APT 208
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1730
Practice Address - Country:US
Practice Address - Phone:989-443-9365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty