Provider Demographics
NPI:1811466808
Name:GIVENS, CONNOR LOUIS (ATC)
Entity type:Individual
Prefix:MR
First Name:CONNOR
Middle Name:LOUIS
Last Name:GIVENS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 BAY HERON PL APT 703
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-2928
Mailing Address - Country:US
Mailing Address - Phone:570-709-7795
Mailing Address - Fax:
Practice Address - Street 1:4805 BAY HERON PL APT 703
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-2928
Practice Address - Country:US
Practice Address - Phone:570-709-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer