Provider Demographics
NPI:1750303608
Name:CONLAN, PENELOPE (LMT)
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:
Last Name:CONLAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N CLYDE MORRIS BLVD
Mailing Address - Street 2:APT 1113
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3904
Mailing Address - Country:US
Mailing Address - Phone:386-872-4277
Mailing Address - Fax:
Practice Address - Street 1:850 N CLYDE MORRIS BLVD
Practice Address - Street 2:APT 1113
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-3904
Practice Address - Country:US
Practice Address - Phone:386-872-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA30911225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist