Provider Demographics
NPI:1730101809
Name:GERI CONNOR PT PLLC
Entity Type:Organization
Organization Name:GERI CONNOR PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-202-1898
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:SENEY
Mailing Address - State:MI
Mailing Address - Zip Code:49883-0038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14460 ROSS LAKE RD
Practice Address - Street 2:
Practice Address - City:SENEY
Practice Address - State:MI
Practice Address - Zip Code:49883-0038
Practice Address - Country:US
Practice Address - Phone:906-202-1898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650G710060OtherBLUE CROSS BLUE SHIELD MI
MI650G710060OtherBLUE CROSS BLUE SHIELD MI