Provider Demographics
NPI:1073587630
Name:CONRAD, CHERYL R (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 GREENSPRING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4112
Mailing Address - Country:US
Mailing Address - Phone:410-560-3931
Mailing Address - Fax:410-560-0877
Practice Address - Street 1:1920 GREENSPRING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4112
Practice Address - Country:US
Practice Address - Phone:410-560-3931
Practice Address - Fax:410-560-0877
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD028N861FMedicare ID - Type UnspecifiedMC ID