Provider Demographics
NPI:1467033894
Name:ERTEL, CONNOR CHRISTOPHER (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:CHRISTOPHER
Last Name:ERTEL
Suffix:
Gender:M
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 1:421 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-2101
Mailing Address - Country:US
Mailing Address - Phone:812-767-2673
Mailing Address - Fax:
Practice Address - Street 1:1111 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-7476
Practice Address - Country:US
Practice Address - Phone:812-346-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010909A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist