Provider Demographics
NPI:1528123031
Name:CONNOR, JOANNA PATRICIA (LMT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:PATRICIA
Last Name:CONNOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CALLE OJO FELIZ
Mailing Address - Street 2:# W
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5737
Mailing Address - Country:US
Mailing Address - Phone:505-577-5330
Mailing Address - Fax:
Practice Address - Street 1:1892A PLAZA DEL SUR DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6043
Practice Address - Country:US
Practice Address - Phone:505-988-8017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist