Provider Demographics
NPI:1083978704
Name:CONLAN, GAIL ANNE (PT)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ANNE
Last Name:CONLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-0348
Mailing Address - Country:US
Mailing Address - Phone:231-590-0105
Mailing Address - Fax:
Practice Address - Street 1:35 WHISPERING WOODS DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7809
Practice Address - Country:US
Practice Address - Phone:231-590-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist