Provider Demographics
NPI:1780658344
Name:CONRAD & RENZI, P.A.
Entity Type:Organization
Organization Name:CONRAD & RENZI, P.A.
Other - Org Name:SPINE AND SPORTS REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-560-3931
Mailing Address - Street 1:7402 YORK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7519
Mailing Address - Country:US
Mailing Address - Phone:410-560-3931
Mailing Address - Fax:410-560-0877
Practice Address - Street 1:7402 YORK RD STE 104
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7519
Practice Address - Country:US
Practice Address - Phone:410-560-3931
Practice Address - Fax:410-560-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD028NMedicare ID - Type UnspecifiedGROUP IDENTIFICATION