Provider Demographics
NPI:1558038026
Name:CONNER, ANDREW TIMOTHY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:TIMOTHY
Last Name:CONNER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 PRIMACY PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0201
Mailing Address - Country:US
Mailing Address - Phone:901-767-8690
Mailing Address - Fax:901-763-1942
Practice Address - Street 1:1244 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0201
Practice Address - Country:US
Practice Address - Phone:901-767-8690
Practice Address - Fax:901-763-1942
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist