Provider Demographics
NPI:1699764217
Name:CONROY, PAMELA B
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:B
Last Name:CONROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 WOODGLEN RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1324
Mailing Address - Country:US
Mailing Address - Phone:272-639-5775
Mailing Address - Fax:
Practice Address - Street 1:2650 WOODGLEN RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1324
Practice Address - Country:US
Practice Address - Phone:272-639-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007515L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01131701OtherCAPITAL
PA689968OtherBLUE SHIELD
PA484416OtherAETNA
PA01131701OtherCAPITAL