Provider Demographics
NPI:1063472041
Name:CONREY, RICHARD WILSON (CPO, PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILSON
Last Name:CONREY
Suffix:
Gender:M
Credentials:CPO, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2834
Mailing Address - Country:US
Mailing Address - Phone:954-584-1954
Mailing Address - Fax:954-584-7794
Practice Address - Street 1:450 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2834
Practice Address - Country:US
Practice Address - Phone:954-584-1954
Practice Address - Fax:954-584-7794
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11703225100000X
FLPOR150222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist