Provider Demographics
NPI:1083160204
Name:CONLEY, BRANDON EDWARD (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:EDWARD
Last Name:CONLEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14012 NY-31 #1
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411
Mailing Address - Country:US
Mailing Address - Phone:585-589-5637
Mailing Address - Fax:
Practice Address - Street 1:14012 ROUTE 31 WEST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9353
Practice Address - Country:US
Practice Address - Phone:585-589-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 040409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist