MEDICARE: BARBARA M. CONNER P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	017754	NY

General Provider Information

NPI Number	:	1366577538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA M. CONNER P.T.

Provider Business Mailing Address
First Line	:	1 CHURCH PL
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-3305
Country	:	US
Telephone Number	:	631-588-8195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CHURCH PL
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-3305
Country	:	US
Telephone Number	:	631-588-8195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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