Provider Demographics
NPI:1639040785
Name:BROWN, CONNOR MARTIN (PT,DPT,CSCS)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:MARTIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT,DPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2389 FORREST RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-6028
Mailing Address - Country:US
Mailing Address - Phone:407-712-4956
Mailing Address - Fax:
Practice Address - Street 1:25 S TERRY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1843
Practice Address - Country:US
Practice Address - Phone:407-641-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT43494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty