Provider Demographics
NPI:1184311375
Name:CONNER, AMBER DANIELLE (PTA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DANIELLE
Last Name:CONNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W LOWRY LN STE 112
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3012
Mailing Address - Country:US
Mailing Address - Phone:859-263-8080
Mailing Address - Fax:
Practice Address - Street 1:175 W LOWRY LN STE 112
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3012
Practice Address - Country:US
Practice Address - Phone:859-263-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant