Provider Demographics
NPI:1780912428
Name:CONNER, SALLY (MSPT)
Entity type:Individual
Prefix:MISS
First Name:SALLY
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 S OCEAN DR APT 1501
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2912
Mailing Address - Country:US
Mailing Address - Phone:954-458-9797
Mailing Address - Fax:954-965-9972
Practice Address - Street 1:3725 S OCEAN DR APT 1501
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2912
Practice Address - Country:US
Practice Address - Phone:954-458-9797
Practice Address - Fax:954-965-9972
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist