Provider Demographics
NPI:1871543173
Name:CONLY, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:CONLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5369
Mailing Address - Country:US
Mailing Address - Phone:203-635-0770
Mailing Address - Fax:203-635-0771
Practice Address - Street 1:1032 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5369
Practice Address - Country:US
Practice Address - Phone:203-635-0770
Practice Address - Fax:203-635-0771
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT49946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0800006345CT01OtherBLUE CROSS ID NUMBER