Provider Demographics
NPI:1780818310
Name:CONNER, ROSEMARY E (MPT, SCS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:E
Last Name:CONNER
Suffix:
Gender:F
Credentials:MPT, SCS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25115 AVENUE STANFORD STE B135
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1290
Mailing Address - Country:US
Mailing Address - Phone:661-250-9940
Mailing Address - Fax:661-250-9959
Practice Address - Street 1:19239 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-1472
Practice Address - Country:US
Practice Address - Phone:661-250-9890
Practice Address - Fax:661-250-9228
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT20486BMedicare PIN