Provider Demographics
NPI:1861810301
Name:CONAWAY, BRYN-MARC (MSAT, LAT, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:BRYN-MARC
Middle Name:
Last Name:CONAWAY
Suffix:
Gender:M
Credentials:MSAT, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14330 OAKHILL PARK LN
Mailing Address - Street 2:STE 115
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14330 OAKHILL PARK LN
Practice Address - Street 2:STE 115
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3314
Practice Address - Country:US
Practice Address - Phone:704-316-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer