Provider Demographics
NPI:1730337551
Name:CONROD, PETER A (PT)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:A
Last Name:CONROD
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:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-0894
Mailing Address - Country:US
Mailing Address - Phone:508-644-5851
Mailing Address - Fax:
Practice Address - Street 1:502 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-4855
Practice Address - Country:US
Practice Address - Phone:508-676-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2003225100000X
RIPT01457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist