Provider Demographics
NPI:1104876069
Name:CONLEY, DAYNE ELLIOTT (PT, MPT, MS, SCS,PES)
Entity type:Individual
Prefix:MR
First Name:DAYNE
Middle Name:ELLIOTT
Last Name:CONLEY
Suffix:
Gender:M
Credentials:PT, MPT, MS, SCS,PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-6005
Mailing Address - Country:US
Mailing Address - Phone:614-792-3831
Mailing Address - Fax:
Practice Address - Street 1:700 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-8011
Practice Address - Country:US
Practice Address - Phone:614-791-0700
Practice Address - Fax:614-791-0702
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist