Provider Demographics
NPI:1548403868
Name:CONQUEST,LLC
Entity Type:Organization
Organization Name:CONQUEST,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:K
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:812-568-0925
Mailing Address - Street 1:6044 WOODBRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8031
Mailing Address - Country:US
Mailing Address - Phone:812-459-3586
Mailing Address - Fax:
Practice Address - Street 1:7145 E VIRGINIA ST
Practice Address - Street 2:SUITE 5000
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9144
Practice Address - Country:US
Practice Address - Phone:812-476-6163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006980A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty