Provider Demographics
NPI:1184749665
Name:CONNORS, MICHAEL JAMES (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:CONNORS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:14380 MARSH LN # 120
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3879
Practice Address - Country:US
Practice Address - Phone:972-942-2097
Practice Address - Fax:972-843-9217
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018053225100000X, 2251X0800X, 2251X0800X
TX1151019225100000X
NJ40QA01239900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX841T78OtherBCBS
TX214442001Medicaid
TX841T78OtherBCBS