Provider Demographics
NPI:1578538518
Name:CONROY, DOUGLAS E (MS, PT,DPT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:E
Last Name:CONROY
Suffix:
Gender:M
Credentials:MS, PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 W. 183RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2868
Mailing Address - Country:US
Mailing Address - Phone:708-957-0095
Mailing Address - Fax:708-957-0096
Practice Address - Street 1:2920 W. 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2868
Practice Address - Country:US
Practice Address - Phone:708-957-0095
Practice Address - Fax:708-957-0096
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617574OtherBCBS
IL1617574OtherBCBS
ILR17746Medicare UPIN