Provider Demographics
NPI:1699914994
Name:CONLEY, JANINE EUGENIO (DPT)
Entity type:Individual
Prefix:MS
First Name:JANINE
Middle Name:EUGENIO
Last Name:CONLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:EUGENIO
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2060 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-1812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 CLEARWATER LARGO RD N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4126
Practice Address - Country:US
Practice Address - Phone:727-586-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016865225100000X
FLPT24572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist