Healthcare Provider Details

I. General information

NPI: 1083308894
Provider Name (Legal Business Name): CONNOR HERRMANN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 W THUNDERBIRD BLVD STE 200
SUN CITY AZ
85351-2746
US

IV. Provider business mailing address

680 AMERICAN AVE
KING OF PRUSSIA PA
19406-4023
US

V. Phone/Fax

Practice location:
  • Phone: 623-888-3370
  • Fax:
Mailing address:
  • Phone: 800-331-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061055T
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number64933
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: