Provider Demographics
NPI:1245897693
Name:CONRAD, ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 LANIER PL NW APT 206
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2942
Mailing Address - Country:US
Mailing Address - Phone:717-870-5492
Mailing Address - Fax:
Practice Address - Street 1:3220 17TH ST NW # 10
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2135
Practice Address - Country:US
Practice Address - Phone:202-436-1279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT2503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist