Provider Demographics
NPI:1609252055
Name:TROTT, CONNOR DAVIS (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CONNOR
Middle Name:DAVIS
Last Name:TROTT
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 1:5650 BAIRD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7117
Mailing Address - Country:US
Mailing Address - Phone:828-506-3072
Mailing Address - Fax:
Practice Address - Street 1:8070 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4068
Practice Address - Country:US
Practice Address - Phone:901-266-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11162225100000X
MSPT5707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist