Provider Demographics
NPI:1457774150
Name:CONLEY, CHRISTY JEAN (LMT, RN)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:JEAN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25411 FRIAR LAKE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-6098
Mailing Address - Country:US
Mailing Address - Phone:832-401-8525
Mailing Address - Fax:
Practice Address - Street 1:25411 FRIAR LAKE LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-6098
Practice Address - Country:US
Practice Address - Phone:832-401-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT119374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist