Individual
BRANDON M. CONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
2400 LAKESIDE DRIVE, SUITE 602F, LYNCHBURG, VA 24501
(434) 338-7215
(434) 212-1936
Mailing address
PO BOX 69030, BALTIMORE, MD 21264-9030
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305208091
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285066209
MEDICAID QMB
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
08/01/2013
Last updated
04/13/2018
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