Provider Demographics
NPI:1508800590
Name:DONNELLY, CORNELIUS JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:JOSEPH
Last Name:DONNELLY
Suffix:
Gender:M
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:PO BOX 297
Mailing Address - Street 2:1230 RT. 16
Mailing Address - City:OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03864-0297
Mailing Address - Country:US
Mailing Address - Phone:603-539-5351
Mailing Address - Fax:603-539-3531
Practice Address - Street 1:1230 ROUTE 16
Practice Address - Street 2:
Practice Address - City:OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03864-7180
Practice Address - Country:US
Practice Address - Phone:603-539-5351
Practice Address - Fax:603-539-3531
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist