Individual
MR. RONALD GLENN CONRAD I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
11971 WAGON WHEEL RD, ROCKTON, IL 61072-3322
(815) 624-2615
Mailing address
608 E HIGH ST, MILTON, WI 53563-1546
(608) 868-5465
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
160-003223
IL
225200000X
Physical Therapy Assistant
Primary
930-019
WI
Other
Enumeration date
05/29/2009
Last updated
05/29/2009
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