Provider Demographics
NPI:1417636580
Name:CONRAD, ADRIAN (LMT)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:CONRAD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 25TH AVE NE STE 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-8667
Mailing Address - Country:US
Mailing Address - Phone:206-315-7998
Mailing Address - Fax:206-316-2308
Practice Address - Street 1:4915 25TH AVE NE STE 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-8667
Practice Address - Country:US
Practice Address - Phone:206-315-7998
Practice Address - Fax:206-316-2308
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61432567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist