Healthcare Provider Details

I. General information

NPI: 1558272385
Provider Name (Legal Business Name): CONRAD H MA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 S HOLLADAY BLVD STE 2
HOLLADAY UT
84117-7169
US

IV. Provider business mailing address

4994 S COMMERCE DR UNIT 616
MURRAY UT
84107-5243
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-1028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number143055992401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: