Provider Demographics
NPI:1972093029
Name:CONQUER FITNESS AND PERFORMANCE LLC
Entity type:Organization
Organization Name:CONQUER FITNESS AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:IV
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:469-305-2598
Mailing Address - Street 1:4681 OHIO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6014
Mailing Address - Country:US
Mailing Address - Phone:469-305-2598
Mailing Address - Fax:
Practice Address - Street 1:4681 OHIO DR STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6014
Practice Address - Country:US
Practice Address - Phone:469-305-2598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy