Provider Demographics
NPI:1407197296
Name:CONRAD, LORI A (DPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:CONRAD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:PANKRATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:88 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1455
Mailing Address - Country:US
Mailing Address - Phone:847-506-1767
Mailing Address - Fax:847-506-9243
Practice Address - Street 1:88 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1455
Practice Address - Country:US
Practice Address - Phone:847-506-1767
Practice Address - Fax:847-506-9243
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist