Provider Demographics
NPI:1811451016
Name:CONILOGUE PT LLC
Entity type:Organization
Organization Name:CONILOGUE PT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CONILOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-490-6432
Mailing Address - Street 1:1401 S MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3771
Mailing Address - Country:US
Mailing Address - Phone:641-209-1446
Mailing Address - Fax:
Practice Address - Street 1:1401 S MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3771
Practice Address - Country:US
Practice Address - Phone:641-209-1446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty