Provider Demographics
NPI:1396863213
Name:JACKSON-CONNER, AUBREY DAHN (DPT)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:DAHN
Last Name:JACKSON-CONNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1305
Mailing Address - Country:US
Mailing Address - Phone:812-343-5369
Mailing Address - Fax:
Practice Address - Street 1:6800 CENTRAL AVE. RM 259
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203
Practice Address - Country:US
Practice Address - Phone:812-799-3455
Practice Address - Fax:812-396-2053
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR059333035OtherBLUE CROSS
OR278540Medicaid
OR183789Medicare PIN