Provider Demographics
NPI:1316082860
Name:CONNER, ADRIENNE TAMARA (PT)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:TAMARA
Last Name:CONNER
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:1829 E FRANKLIN ST
Mailing Address - Street 2:BLDG. # 600
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5861
Mailing Address - Country:US
Mailing Address - Phone:919-968-3456
Mailing Address - Fax:919-932-3456
Practice Address - Street 1:1829 E FRANKLIN ST
Practice Address - Street 2:BLDG. # 600
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5861
Practice Address - Country:US
Practice Address - Phone:919-968-3456
Practice Address - Fax:919-932-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10917225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212189Medicaid
NC068E7OtherBLUE CROSS