Provider Demographics
NPI:1962545137
Name:CONLEY, KELLEY A (PT)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:A
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KELLEY
Other - Middle Name:A
Other - Last Name:STEHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 162743
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2743
Mailing Address - Country:US
Mailing Address - Phone:954-580-4084
Mailing Address - Fax:561-968-9969
Practice Address - Street 1:4800 NE 20TH TER STE 303
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-441-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36294225100000X, 225100000X
NH3929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66398OtherBLUE CROSS
MA0397865Medicaid
MACOY68406Medicare PIN
MA0397865Medicaid