Provider Demographics
NPI:1528569795
Name:CONNELLY, KATHLEEN M (PT,DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 BENJAMIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1473
Mailing Address - Country:US
Mailing Address - Phone:732-886-6996
Mailing Address - Fax:732-886-8862
Practice Address - Street 1:213 BENJAMIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1473
Practice Address - Country:US
Practice Address - Phone:732-886-6996
Practice Address - Fax:732-886-8862
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01628000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist