MEDICARE: ANNA LI-CONRAD PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	014392	OH

General Provider Information

NPI Number	:	1427452515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA LI-CONRAD PT, DPT

Provider Business Mailing Address
First Line	:	5606 WILSON MILLS RD
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3210
Country	:	US
Telephone Number	:	440-449-1866
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 WILSON MILLS RD
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3210
Country	:	US
Telephone Number	:	440-449-1866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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