Provider Demographics
NPI:1538312186
Name:MCALEAVEY, CONNIE JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JEAN
Last Name:MCALEAVEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2352
Mailing Address - Country:US
Mailing Address - Phone:715-425-9797
Mailing Address - Fax:
Practice Address - Street 1:232 SPRINGER AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:WI
Practice Address - Zip Code:54740-8806
Practice Address - Country:US
Practice Address - Phone:715-639-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI489-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant