Provider Demographics
NPI:1184731945
Name:CONARD, CHERYL M (PT)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:M
Last Name:CONARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:C
Other - Last Name:HAIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3021 VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8303
Mailing Address - Country:US
Mailing Address - Phone:920-437-7246
Mailing Address - Fax:920-437-1511
Practice Address - Street 1:300 N BROADWAY
Practice Address - Street 2:SUITE 3C
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2702
Practice Address - Country:US
Practice Address - Phone:920-437-7246
Practice Address - Fax:920-437-1511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2368024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4029180000Medicaid
WI2368-024OtherLICENSE
WI4029180000Medicaid