Provider Demographics
NPI:1871551648
Name:PARTIN, CONNIE LYNN (MS, PT)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LYNN
Last Name:PARTIN
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9067
Mailing Address - Country:US
Mailing Address - Phone:479-967-7257
Mailing Address - Fax:479-967-7257
Practice Address - Street 1:2807 W 19TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9067
Practice Address - Country:US
Practice Address - Phone:479-967-7257
Practice Address - Fax:479-967-7257
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S700OtherABCBS PROVIDER NUMBER