Healthcare Provider Details

I. General information

NPI: 1194337634
Provider Name (Legal Business Name): ZACHARY MICHAEL CONLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

8196 MEDLEY ST APT 203
AVON IN
46123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-3420
  • Fax:
Mailing address:
  • Phone: 269-615-1077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013779A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: