Provider Demographics
NPI:1083470843
Name:CONNECT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CONNECT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:WYATT
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:407-868-3379
Mailing Address - Street 1:12021 PIONEERS WAY APT 1311
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-2804
Mailing Address - Country:US
Mailing Address - Phone:407-868-3379
Mailing Address - Fax:
Practice Address - Street 1:12021 PIONEERS WAY APT 1311
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-2804
Practice Address - Country:US
Practice Address - Phone:407-868-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy