Provider Demographics
NPI:1811529761
Name:NORMAN, CONNOR (PT, CSCS)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:NORMAN
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 COLD TREE CT
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2367
Mailing Address - Country:US
Mailing Address - Phone:678-612-1790
Mailing Address - Fax:
Practice Address - Street 1:1 SELIG CIR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1501
Practice Address - Country:US
Practice Address - Phone:706-542-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0131472251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports