Provider Demographics
NPI:1770560963
Name:HOWARD, CONNIE A (PT)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:A
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 CHESTNUT ST
Mailing Address - Street 2:PO BOX 29
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056-2347
Mailing Address - Country:US
Mailing Address - Phone:316-680-8192
Mailing Address - Fax:
Practice Address - Street 1:119 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HALSTEAD
Practice Address - State:KS
Practice Address - Zip Code:67056-1604
Practice Address - Country:US
Practice Address - Phone:316-680-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1770560963OtherNPI