Provider Demographics
NPI:1942951439
Name:CONAWAY, CHRISTIAN GRANT (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:GRANT
Last Name:CONAWAY
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 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:888-653-0454
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:704 N JUDD PKWY NE STE 100
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1989
Practice Address - Country:US
Practice Address - Phone:919-896-7158
Practice Address - Fax:919-896-7208
Is Sole Proprietor?:No
Enumeration Date:2022-01-16
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist