Provider Demographics
NPI:1619351459
Name:PLAVNICK, CONNIE MCDANIEL (PT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MCDANIEL
Last Name:PLAVNICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:KAYE
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4387 LEISURE TIME DR
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3242
Mailing Address - Country:US
Mailing Address - Phone:228-255-3533
Mailing Address - Fax:
Practice Address - Street 1:4387 LEISURE TIME DR
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3242
Practice Address - Country:US
Practice Address - Phone:228-255-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist