Basic Information
| Provider Information | |||||||||
| NPI: | 1033448154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COONRADT | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPTA, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5319 FLAGLER DR | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240196311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402931660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1454 MEXICO WAY NE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240126476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407728022 | ||||||||
| FaxNumber: | 5403456338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2009 | ||||||||
| LastUpdateDate: | 05/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0126000486 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 225200000X | 2306602864 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 3144 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.