1992098198 NPI number — MRS. EMILIE CLARK CONNOR DPT, PT

Table of content: MRS. EMILIE CLARK CONNOR DPT, PT (NPI 1992098198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992098198 NPI number — MRS. EMILIE CLARK CONNOR DPT, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNOR
Provider First Name:
EMILIE
Provider Middle Name:
CLARK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT, PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992098198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTPELIER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05602-3792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-262-1500
Provider Business Mailing Address Fax Number:
802-262-1505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTPELIER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-262-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  040-0067760 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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