Provider Demographics
NPI:1225539943
Name:O'CONNOR, PATRICK DONALD (PT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:DONALD
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27404 SW 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-4388
Mailing Address - Country:US
Mailing Address - Phone:352-317-8493
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER ROAD
Practice Address - Street 2:REHAB SERVICES
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0015260225100000X
FLPT5482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT5482OtherSTATE OF FLORIDA BOARD OF TPHYSICAL THERAPY
COPTL0015260OtherCOLORADO DEPT OF REGULATORY AGENCIES