Provider Demographics
NPI:1689992000
Name:CONNER, JENNIFER NICOLE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:CONNER
Suffix:
Gender:F
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 1:2117 ELEVEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3553
Mailing Address - Country:US
Mailing Address - Phone:586-573-4684
Mailing Address - Fax:586-573-2575
Practice Address - Street 1:2117 ELEVEN MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3553
Practice Address - Country:US
Practice Address - Phone:586-573-4684
Practice Address - Fax:586-573-2575
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2018-06-20
Deactivation Date:2018-04-13
Deactivation Code:
Reactivation Date:2018-06-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist