Provider Demographics
NPI:1326597758
Name:CONLEY, KOLLEEN (MA,CNMT,CNMFR)
Entity Type:Individual
Prefix:MS
First Name:KOLLEEN
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MA,CNMT,CNMFR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 MAITLAND CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2477
Mailing Address - Country:US
Mailing Address - Phone:719-271-8739
Mailing Address - Fax:
Practice Address - Street 1:1620 MAITLAND CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2477
Practice Address - Country:US
Practice Address - Phone:719-271-8739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0008042172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist