Provider Demographics
NPI:1497973440
Name:CONLEY, ANGELA DAWN
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 CURRY LANE APT 3713
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:806-786-1881
Mailing Address - Fax:
Practice Address - Street 1:ABILENE STATE SCHOOL
Practice Address - Street 2:2501 MAPLE STREET
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79604
Practice Address - Country:US
Practice Address - Phone:325-795-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1173243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist