Provider Demographics
NPI:1043723307
Name:CONNOLLY, CHELSA ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:CHELSA
Middle Name:ELIZABETH
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E LOOP 281 STE 20
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7931
Mailing Address - Country:US
Mailing Address - Phone:903-309-3756
Mailing Address - Fax:
Practice Address - Street 1:414 E LOOP 281 STE 20
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7931
Practice Address - Country:US
Practice Address - Phone:903-309-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist