Provider Demographics
NPI:1912788910
Name:SMITH, CONNOR (DPT)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
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Mailing Address - Street 1:1366 CORDILLERAS AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4404
Mailing Address - Country:US
Mailing Address - Phone:408-394-3682
Mailing Address - Fax:
Practice Address - Street 1:3141 TIGER RUN CT STE 114
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6706
Practice Address - Country:US
Practice Address - Phone:760-585-2178
Practice Address - Fax:833-409-6554
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT3044102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic