Provider Demographics
NPI:1790673135
Name:MCDERMOTT, CONNOR (DPT, PT)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W 2ND ST APT 2207
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2173
Mailing Address - Country:US
Mailing Address - Phone:816-248-1660
Mailing Address - Fax:
Practice Address - Street 1:1800 WYANDOTTE ST STE 201
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1953
Practice Address - Country:US
Practice Address - Phone:816-605-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025023832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist