Provider Demographics
NPI:1255479150
Name:CONRAD, MARGARET DIANA (LPT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:DIANA
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 STANTON CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5440
Mailing Address - Country:US
Mailing Address - Phone:817-377-3422
Mailing Address - Fax:817-735-8615
Practice Address - Street 1:3600 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2534
Practice Address - Country:US
Practice Address - Phone:817-377-3422
Practice Address - Fax:817-735-8615
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist