Provider Demographics
NPI:1093836967
Name:MCCONNAHA, COLLEEN ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANN
Last Name:MCCONNAHA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 WILLOW TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4420
Mailing Address - Country:US
Mailing Address - Phone:636-922-3332
Mailing Address - Fax:
Practice Address - Street 1:4525 CENTRAL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7113
Practice Address - Country:US
Practice Address - Phone:636-851-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist