Provider Demographics
NPI:1902972490
Name:CONROY, ELIZABETH ULLAINE (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ULLAINE
Last Name:CONROY
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 1:307 KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2536
Mailing Address - Country:US
Mailing Address - Phone:301-464-1893
Mailing Address - Fax:301-464-1824
Practice Address - Street 1:4351 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2602
Practice Address - Country:US
Practice Address - Phone:301-464-1893
Practice Address - Fax:301-464-1824
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD529115 01OtherCAREFIRST
S891 0003OtherCAREFIRST
MD529115 01OtherCAREFIRST