Individual
JEREMY LARKIN CONOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
255 W BROWN RD, MESA, AZ 85201-3404
(480) 329-8975
Mailing address
255 W BROWN RD, MESA, AZ 85201-3404
(480) 329-8975
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
012680
AZ
Other
Enumeration date
12/07/2018
Last updated
12/07/2018
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