Provider Demographics
NPI:1891526448
Name:DANIEL, CONRAD JOSEPH (LMT, CPT)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:JOSEPH
Last Name:DANIEL
Suffix:
Gender:M
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 COPLEY RD STE 18
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2142
Mailing Address - Country:US
Mailing Address - Phone:330-808-8119
Mailing Address - Fax:
Practice Address - Street 1:2830 COPLEY RD STE 18
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2142
Practice Address - Country:US
Practice Address - Phone:330-808-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist