Provider Demographics
NPI:1689630360
Name:CONNOR, KAREN L (PT)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:CONNOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5735
Mailing Address - Country:US
Mailing Address - Phone:216-200-6978
Mailing Address - Fax:
Practice Address - Street 1:24700 CENTER RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5606
Practice Address - Country:US
Practice Address - Phone:216-200-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110622251X0800X
OHPT011062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000359891OtherANTHEM BCBS
OH341490517044OtherCARESOURCE
OH654140OtherAETNA