MEDICARE: CONNOR BRETT COUNCE DPT

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	1320619	TX

General Provider Information

NPI Number	:	1649828450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR BRETT COUNCE DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-541-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 W FM 120 STE 103
Second Line	:
City	:	DENISON
State	:	TX
Zip	:	75020-1556
Country	:	US
Telephone Number	:	903-337-1362
Fax Number	:	903-337-1377

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

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	08/27/2019

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Directions to “ CONNOR BRETT COUNCE DPT” Practice Location

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