Provider Demographics
NPI:1992915565
Name:KONRADE, JASON LYLE (PT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:LYLE
Last Name:KONRADE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 21000 RD
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-8265
Mailing Address - Country:US
Mailing Address - Phone:620-421-4949
Mailing Address - Fax:
Practice Address - Street 1:2917 W HWY 50
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801
Practice Address - Country:US
Practice Address - Phone:620-343-9900
Practice Address - Fax:620-343-9904
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist