Provider Demographics
NPI:1811409543
Name:CONNOR, BRIAN ROBERT
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ROBERT
Last Name:CONNOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 LOOMIS AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-3207
Mailing Address - Country:US
Mailing Address - Phone:615-668-2438
Mailing Address - Fax:
Practice Address - Street 1:1159 LOOMIS AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-3207
Practice Address - Country:US
Practice Address - Phone:615-668-2438
Practice Address - Fax:615-668-2438
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant