Provider Demographics
NPI:1275514747
Name:CONNORS, CHARLES V (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:V
Last Name:CONNORS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:168 INDUSTRIAL DR
Mailing Address - Street 2:UNIT 5
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3404
Mailing Address - Country:US
Mailing Address - Phone:508-477-4800
Mailing Address - Fax:508-477-5377
Practice Address - Street 1:168 INDUSTRIAL DR
Practice Address - Street 2:UNIT 5
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3404
Practice Address - Country:US
Practice Address - Phone:508-477-4800
Practice Address - Fax:508-477-5377
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA16681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69395Medicare ID - Type Unspecified