Provider Demographics
NPI:1871825992
Name:PIRKLE, CONNIE M (PT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:M
Last Name:PIRKLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:MARIE
Other - Last Name:MANGRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6711 MOUNTAIN VIEW RD STE 115
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6667
Mailing Address - Country:US
Mailing Address - Phone:423-238-1127
Mailing Address - Fax:423-238-1277
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5885
Practice Address - Country:US
Practice Address - Phone:702-998-3333
Practice Address - Fax:702-260-4051
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT2333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist