Provider Demographics
NPI:1821267626
Name:MCCONNELL, BRIAN (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 W 173RD PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1011
Mailing Address - Country:US
Mailing Address - Phone:310-614-8946
Mailing Address - Fax:
Practice Address - Street 1:17332 VON KARMAN AVE
Practice Address - Street 2:120
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6242
Practice Address - Country:US
Practice Address - Phone:949-861-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist