Provider Demographics
NPI:1205690211
Name:DAVIS, CONNOR MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:MICHAEL
Last Name:DAVIS
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 1:2505 KILBORNE DR APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5377
Mailing Address - Country:US
Mailing Address - Phone:704-771-8205
Mailing Address - Fax:
Practice Address - Street 1:970 BRANCHVIEW DR NE STE 160
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2234
Practice Address - Country:US
Practice Address - Phone:704-782-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist