Individual
DR. JAKE CONLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
5510 AIRLINE DR STE 104, BOSSIER CITY, LA 71111-6728
(318) 935-9075
(318) 935-9076
Mailing address
PO BOX 255, STONEWALL, LA 71078-0255
(318) 470-3111
(318) 935-9076
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10888
LA
Other
Enumeration date
05/12/2021
Last updated
05/12/2021
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