Provider Demographics
NPI:1346362381
Name:CONNOLLY, SHARON ANNE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANNE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PINE POINT RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2215
Mailing Address - Country:US
Mailing Address - Phone:207-332-2499
Mailing Address - Fax:
Practice Address - Street 1:4 PINE POINT RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2215
Practice Address - Country:US
Practice Address - Phone:207-332-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1837Medicare ID - Type Unspecified