Provider Demographics
NPI:1073148599
Name:CONRAD, DAVID J JR
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CONRAD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 GOODFELLOW CT
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:81527-8903
Mailing Address - Country:US
Mailing Address - Phone:970-210-2326
Mailing Address - Fax:
Practice Address - Street 1:2121 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6428
Practice Address - Country:US
Practice Address - Phone:970-242-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0009114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist