Healthcare Provider Details

I. General information

NPI: 1043986151
Provider Name (Legal Business Name): CONNER ELISE OLNEY DPY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7979 W RIFLEMAN ST STE 200
BOISE ID
83704-9066
US

IV. Provider business mailing address

3037 S BETSY ROSS LN
BOISE ID
83706-5072
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-3850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: