Provider Demographics
NPI:1932369774
Name:CONNOR, JESSE JAMES (PAS,LMT,NMT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:JAMES
Last Name:CONNOR
Suffix:
Gender:M
Credentials:PAS,LMT,NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 STONECREEK PL
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-7656
Mailing Address - Country:US
Mailing Address - Phone:205-529-6062
Mailing Address - Fax:205-822-0899
Practice Address - Street 1:2010 PATTON CHAPEL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5782
Practice Address - Country:US
Practice Address - Phone:205-529-6062
Practice Address - Fax:205-822-0899
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1353225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist