Provider Demographics
NPI:1346415999
Name:CONNOR, EMILIE D (PT, LAC)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:D
Last Name:CONNOR
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MAIN ST S STE 204
Mailing Address - Street 2:C/O HOLISTIC HEALTH CENTER
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2275
Mailing Address - Country:US
Mailing Address - Phone:203-264-6624
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST S STE 204
Practice Address - Street 2:C/O HOLISTIC HEALTH CENTER
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2275
Practice Address - Country:US
Practice Address - Phone:203-264-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000036171100000X
CT003704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist