Provider Demographics
NPI:1992337786
Name:LINGO, CONNOR STEVEN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:STEVEN
Last Name:LINGO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 KIRKWOOD HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5131
Mailing Address - Country:US
Mailing Address - Phone:302-635-9009
Mailing Address - Fax:302-449-2047
Practice Address - Street 1:4345 KIRKWOOD HWY STE 201
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5131
Practice Address - Country:US
Practice Address - Phone:302-635-9009
Practice Address - Fax:302-449-2047
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0004183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist