Provider Demographics
NPI:1417149568
Name:CONNELLY, JAMES M (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1013
Mailing Address - Country:US
Mailing Address - Phone:407-322-3442
Mailing Address - Fax:407-322-8404
Practice Address - Street 1:290 CLYDE MORRIS BLVD STE A1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8204
Practice Address - Country:US
Practice Address - Phone:386-898-0443
Practice Address - Fax:386-898-0459
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT15513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist