Provider Demographics
NPI:1679872170
Name:DIAS, KONRAD JOSPEH (DPT)
Entity type:Individual
Prefix:DR
First Name:KONRAD
Middle Name:JOSPEH
Last Name:DIAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 TRAGO CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4405
Mailing Address - Country:US
Mailing Address - Phone:314-529-9698
Mailing Address - Fax:
Practice Address - Street 1:650 MARYVILLE UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5849
Practice Address - Country:US
Practice Address - Phone:314-529-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004030332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist