Healthcare Provider Details

I. General information

NPI: 1356394878
Provider Name (Legal Business Name): KERRY CONLEY HORAN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 JOG RD
DELRAY BEACH FL
33446-3806
US

IV. Provider business mailing address

7745 W LAKE DR
WEST PALM BEACH FL
33406-8741
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-5144
  • Fax: 561-496-5201
Mailing address:
  • Phone: 561-496-5144
  • Fax: 561-496-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: