Healthcare Provider Details

I. General information

NPI: 1285602029
Provider Name (Legal Business Name): ELIZABETH ANN CONLEY PT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 161ST AVE NE SUITE 103
REDMOND WA
98052-3858
US

IV. Provider business mailing address

8301 161ST AVE NE SUITE 103
REDMOND WA
98052
US

V. Phone/Fax

Practice location:
  • Phone: 425-284-1767
  • Fax: 425-284-3302
Mailing address:
  • Phone: 425-284-1767
  • Fax: 425-284-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00005502
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: