Provider Demographics
NPI:1205039039
Name:CONNORS, KATHERINE ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANNE
Last Name:CONNORS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 RICHMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3811
Mailing Address - Country:US
Mailing Address - Phone:718-351-6500
Mailing Address - Fax:
Practice Address - Street 1:2052 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3916
Practice Address - Country:US
Practice Address - Phone:718-351-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008563-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist