Provider Demographics
NPI:1598258956
Name:COONRADT, DYLAN ROBERT (DPT)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:ROBERT
Last Name:COONRADT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 MEDICAL CENTER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2404
Mailing Address - Country:US
Mailing Address - Phone:702-222-1000
Mailing Address - Fax:702-222-9448
Practice Address - Street 1:8751 W CHARLESTON BLVD STE 270
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5497
Practice Address - Country:US
Practice Address - Phone:702-982-2232
Practice Address - Fax:702-982-2237
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist