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General NPI Number Information
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NPI Number | 1023661915
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Entity Type | Individual
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Provider Name | CONNOR PRATT
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Gender | Male
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 635 LOCUST ST UNIT 116
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City | SAINT LOUIS
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State | MO
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Zip | 63101-1700
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Country | US
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Telephone | 314-241-1891
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Fax |
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Provider Business Mailing Address
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Address Line | 6990 E SHEA BLVD STE 108
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5208
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Country | US
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Telephone | 480-590-4412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2019021009
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT015305
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License Number State | AZ
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