Provider Demographics
NPI:1669238739
Name:CONRAD, TAWNIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:TAWNIE
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 HAMILTON LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-7376
Mailing Address - Country:US
Mailing Address - Phone:425-327-6792
Mailing Address - Fax:
Practice Address - Street 1:1070 HAMILTON LN
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-7376
Practice Address - Country:US
Practice Address - Phone:425-327-6792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant