Healthcare Provider Details

I. General information

NPI: 1871715474
Provider Name (Legal Business Name): CONRAD THOMAS LANDING PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 GOVENORS HILL DR.
CINCINNATI OH
45249
US

IV. Provider business mailing address

4759 REXWOOD DR.
DAYTON OH
45439
US

V. Phone/Fax

Practice location:
  • Phone: 866-791-5766
  • Fax:
Mailing address:
  • Phone: 937-294-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 01320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: