Provider Demographics
NPI:1033448154
Name:COONRADT, EMILY P (LPTA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:P
Last Name:COONRADT
Suffix:
Gender:F
Credentials:LPTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-6311
Mailing Address - Country:US
Mailing Address - Phone:540-293-1660
Mailing Address - Fax:
Practice Address - Street 1:1454 MEXICO WAY NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6476
Practice Address - Country:US
Practice Address - Phone:540-772-8022
Practice Address - Fax:540-345-6338
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260004862255A2300X
VA2306602864225200000X
SC3144225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer