Provider Demographics
NPI:1316312390
Name:CONRAD, ZHANNA (PT)
Entity type:Individual
Prefix:
First Name:ZHANNA
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ZHANNA
Other - Middle Name:
Other - Last Name:TSYKUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:725 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE C103
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6012
Mailing Address - Country:US
Mailing Address - Phone:808-596-4650
Mailing Address - Fax:808-596-4651
Practice Address - Street 1:725 KAPIOLANI BLVD
Practice Address - Street 2:SUITE C103
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6012
Practice Address - Country:US
Practice Address - Phone:808-596-4650
Practice Address - Fax:808-596-4651
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT3810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist