Provider Demographics
NPI:1780644278
Name:CONNER, ROBERT L III (PT, MPT, CSCS, FAFS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:CONNER
Suffix:III
Gender:M
Credentials:PT, MPT, CSCS, FAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 S 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3052
Mailing Address - Country:US
Mailing Address - Phone:248-854-8188
Mailing Address - Fax:
Practice Address - Street 1:9805 S 51ST AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3052
Practice Address - Country:US
Practice Address - Phone:248-854-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700151302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30374OtherBCBS
MI10951OtherMCARE
MI10951OtherMCARE
MI236613Medicare ID - Type Unspecified