Provider Demographics
NPI:1497391494
Name:SUNDAY, CONNER R (LMT)
Entity Type:Individual
Prefix:
First Name:CONNER
Middle Name:R
Last Name:SUNDAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CONNER
Other - Middle Name:
Other - Last Name:HOESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:N45523 OLD 53 RD
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758-9255
Mailing Address - Country:US
Mailing Address - Phone:715-559-0857
Mailing Address - Fax:
Practice Address - Street 1:13512 9TH ST
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758-8775
Practice Address - Country:US
Practice Address - Phone:715-597-3388
Practice Address - Fax:715-597-2688
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist