Basic Information
| Provider Information | |||||||||
| NPI: | 1114953411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCONNELL | ||||||||
| FirstName: | PIMA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 CONNIE CIR | ||||||||
| Address2: | |||||||||
| City: | PINE MOUNTAIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 318224712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069770846 | ||||||||
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| Practice Location | |||||||||
| Address1: | 159 S COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 318115306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066284622 | ||||||||
| FaxNumber: | 7066289159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 01/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT001885 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.