Active NPI
Richard Wilson Conrey, CPO, PT
- Prosthetist
- Plantation, FL
National Provider Identifier
1063472041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- POR150
- Practice address
- 450 N State Road 7
Plantation, FL 33317-2834 - Phone
- (954) 584-1954
- Fax
- (954) 584-7794
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT11703 | FL | |
| Orthotist | 222Z00000X | POR150 | FL | |
| Prosthetist | 224P00000X | POR150 | FL | Primary |
Addresses
Primary practice location
450 N State Road 7
Plantation, FL 33317-2834
Mailing address
450 N State Road 7
Plantation, FL 33317-2834
Phone (954) 584-1954
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| POR150 | FL | MD | Prosthetist |
| PT11703 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570752000000",
"number": "1063472041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 N STATE ROAD 7",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333172834",
"telephone_number": "954-584-1954",
"fax_number": "954-584-7794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 N STATE ROAD 7",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333172834",
"telephone_number": "954-584-1954",
"fax_number": "954-584-7794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONREY",
"first_name": "RICHARD",
"middle_name": "WILSON",
"credential": "CPO, PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2019-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT11703",
"primary": false
},
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "FL",
"license": "POR150",
"primary": false
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "FL",
"license": "POR150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plantation, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.