Provider Demographics
NPI:1033235007
Name:CONLEY, KELLY ANN (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 NORTHEAST EXPRESSWAY NE
Mailing Address - Street 2:BUILDING 8, SUITE C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:770-500-3848
Mailing Address - Fax:678-868-1114
Practice Address - Street 1:3300 NORTHEAST EXPRESSWAY NE
Practice Address - Street 2:BUILDING 8, SUITE C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:770-500-3848
Practice Address - Fax:678-868-1114
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7747225100000X
GAPT007747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist