Healthcare Provider Details

I. General information

NPI: 1376247155
Provider Name (Legal Business Name): CONNOR MCNAMARA NELSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 40TH STREET WAY
OAKLAND CA
94611-5612
US

IV. Provider business mailing address

202 N CEDAR AVE STE 1
OWATONNA MN
55060-2306
US

V. Phone/Fax

Practice location:
  • Phone: 510-658-2041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12959
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310933
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40056
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0020955
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number88982
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: