Provider Demographics
NPI:1124124490
Name:CONRAD, LAURIE S (PT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:S
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-7003
Mailing Address - Country:US
Mailing Address - Phone:814-886-4012
Mailing Address - Fax:
Practice Address - Street 1:1041 3RD AVE
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-1351
Practice Address - Country:US
Practice Address - Phone:814-696-3873
Practice Address - Fax:814-696-3877
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009154E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7735639OtherAETNA NON-HMO
PA259359OtherHEALTH AMER/HEALTH ASSUR.
PACO1696441OtherHIGHMARK BLUE SHIELD
PA259359OtherHEALTH AMER/HEALTH ASSUR.