Provider Demographics
NPI:1801689864
Name:CONROY, MICHAEL TIMOTHY (LMT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:CONROY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 S SHERIDAN RD STE C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6776
Mailing Address - Country:US
Mailing Address - Phone:918-701-0263
Mailing Address - Fax:
Practice Address - Street 1:10106 S SHERIDAN RD STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6776
Practice Address - Country:US
Practice Address - Phone:918-701-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK204607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist