Provider Demographics
NPI:1518980085
Name:CONRAD, CAROL A (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0895
Mailing Address - Country:US
Mailing Address - Phone:410-876-5600
Mailing Address - Fax:410-876-1623
Practice Address - Street 1:532 BALTIMORE BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6117
Practice Address - Country:US
Practice Address - Phone:410-876-5600
Practice Address - Fax:410-876-1623
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD533299OtherBCBS MD
MD221ML218Medicare ID - Type Unspecified
MDS19664Medicare UPIN