Provider Demographics
NPI:1275025173
Name:KNOBLE, CONNER (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CONNER
Middle Name:
Last Name:KNOBLE
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12175 734 RD
Mailing Address - Street 2:
Mailing Address - City:FUNK
Mailing Address - State:NE
Mailing Address - Zip Code:68940-4073
Mailing Address - Country:US
Mailing Address - Phone:308-830-2556
Mailing Address - Fax:
Practice Address - Street 1:1800 W SOUTH COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-2378
Practice Address - Country:US
Practice Address - Phone:903-873-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer