Provider Demographics
NPI:1831524362
Name:CARTER, CONRAD (DPT)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:CARTER
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 1:4321 HARTWICK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3210
Mailing Address - Country:US
Mailing Address - Phone:301-277-6616
Mailing Address - Fax:
Practice Address - Street 1:4321 HARTWICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3210
Practice Address - Country:US
Practice Address - Phone:301-277-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist