Provider Demographics
NPI:1124364062
Name:CONNELL, ALYSON (CMT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:CONNELL
Other - Last Name:SCHLOBOHM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:1311 WESTBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3309
Mailing Address - Country:US
Mailing Address - Phone:804-516-4285
Mailing Address - Fax:
Practice Address - Street 1:4025 MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4050
Practice Address - Country:US
Practice Address - Phone:804-516-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019009106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist