Provider Demographics
NPI:1750697611
Name:CONNOR, JEAN M (MA18357)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MA18357
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 51ST ST E
Mailing Address - Street 2:APT. 414 B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5538
Mailing Address - Country:US
Mailing Address - Phone:239-218-3045
Mailing Address - Fax:
Practice Address - Street 1:702 51ST ST E
Practice Address - Street 2:APT. 414 B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5538
Practice Address - Country:US
Practice Address - Phone:239-218-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist