Provider Demographics
NPI:1851591218
Name:CONWAY, MARION ROSE (PT)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:ROSE
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARION
Other - Middle Name:ROSE
Other - Last Name:MESERVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0019
Mailing Address - Country:US
Mailing Address - Phone:518-350-4454
Mailing Address - Fax:518-802-3059
Practice Address - Street 1:1 ROSELL DR STE 2
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1431
Practice Address - Country:US
Practice Address - Phone:518-350-4454
Practice Address - Fax:518-802-3059
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21965225100000X
WAPT60836196225100000X
MN8061225100000X
NJ40QA01374600225100000X
NY031192225100000X
NY62 031192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist