Healthcare Provider Details

I. General information

NPI: 1639040785
Provider Name (Legal Business Name): CONNOR MARTIN BROWN PT,DPT,CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 10/24/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S TERRY AVE
ORLANDO FL
32805-1843
US

IV. Provider business mailing address

2389 FORREST RD
WINTER PARK FL
32789-6028
US

V. Phone/Fax

Practice location:
  • Phone: 407-641-2446
  • Fax:
Mailing address:
  • Phone: 407-712-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: