Provider Demographics
NPI:1164807368
Name:COX, CONNIE (MMP,LMT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:MMP,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41241
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-1241
Mailing Address - Country:US
Mailing Address - Phone:901-650-8512
Mailing Address - Fax:
Practice Address - Street 1:4911 WILLIAM ARNOLD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4237
Practice Address - Country:US
Practice Address - Phone:901-650-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8068OtherLMT NO.