| Organization Name: | PHOENIX CONQUEST, LLC |
| NPI Number: | 1225361074 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK WATSON (CEO) |
| Mailing Address: | 228 Adams Pointe Blvd Suite #6 Mars |
| State: | PA US |
| Postal Code: | 160464667 |
| Phone Number: | 4123021668 |
| Fax Number: | |
| NPI Enumeration Date: | 09/11/2009 |
| NPI Last Update Date: | 09/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |