Provider Demographics
NPI:1770543027
Name:CONNELL, AARON LEE (MPT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:LEE
Last Name:CONNELL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-254-5217
Practice Address - Street 1:7937 RHEA COUNTY HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5990
Practice Address - Country:US
Practice Address - Phone:423-570-0907
Practice Address - Fax:423-570-0936
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013102225100000X
TN7298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511235Medicaid
TN446631Medicare ID - Type UnspecifiedGROUP #