Provider Demographics
NPI:1073799409
Name:MCCONNELL, CHRISTOPHER G (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N WOOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2719
Mailing Address - Country:US
Mailing Address - Phone:330-602-8872
Mailing Address - Fax:330-602-8872
Practice Address - Street 1:1000 N WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2719
Practice Address - Country:US
Practice Address - Phone:330-602-8872
Practice Address - Fax:330-602-8872
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5584225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist