Healthcare Provider Details

I. General information

NPI: 1770543027
Provider Name (Legal Business Name): AARON LEE CONNELL MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7937 RHEA COUNTY HWY SUITE 104
DAYTON TN
37321-5990
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 423-570-0907
  • Fax: 423-570-0936
Mailing address:
  • Phone: 423-238-8930
  • Fax: 423-254-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013102
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7298
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: