Provider Demographics
NPI:1467442962
Name:CONRAD, STEPHEN R (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:CONRAD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1225 E WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3805
Mailing Address - Country:US
Mailing Address - Phone:330-724-7545
Mailing Address - Fax:330-724-8727
Practice Address - Street 1:1225 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3805
Practice Address - Country:US
Practice Address - Phone:330-724-7545
Practice Address - Fax:330-724-8727
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHPT01529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT01529OtherOT PT ATC BOARD