Provider Demographics
NPI:1578046629
Name:BRUNS, CONNER (DPT)
Entity Type:Individual
Prefix:
First Name:CONNER
Middle Name:
Last Name:BRUNS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W WACKERLY ST STE 2600
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4710
Mailing Address - Country:US
Mailing Address - Phone:989-794-2941
Mailing Address - Fax:989-794-2942
Practice Address - Street 1:555 W WACKERLY ST STE 2600
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4710
Practice Address - Country:US
Practice Address - Phone:989-794-2941
Practice Address - Fax:989-794-2942
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist