Provider Demographics
NPI:1336518752
Name:CONRAD, MEGAN MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MICHELLE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MICHELLE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-0870
Mailing Address - Country:US
Mailing Address - Phone:814-506-8212
Mailing Address - Fax:814-506-8213
Practice Address - Street 1:4702 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004-9251
Practice Address - Country:US
Practice Address - Phone:717-935-2105
Practice Address - Fax:717-935-5109
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010633225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant