Provider Demographics
NPI:1235637307
Name:CONNOR, JULIA WYATT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:WYATT
Last Name:CONNOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 SANCTUARY CREEK WAY UNIT 307
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6615
Mailing Address - Country:US
Mailing Address - Phone:704-692-2881
Mailing Address - Fax:
Practice Address - Street 1:831 SIMPSON RD STE 102
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5328
Practice Address - Country:US
Practice Address - Phone:407-483-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist