Provider Demographics
NPI:1023570546
Name:CONNOR, REBECCA KATHERINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:KATHERINE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 KETTERING RD
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2341
Mailing Address - Country:US
Mailing Address - Phone:865-448-3875
Mailing Address - Fax:
Practice Address - Street 1:122 CAVETTE HILL LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-6674
Practice Address - Country:US
Practice Address - Phone:865-777-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4313225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant