Provider Demographics
NPI:1558974352
Name:MCCONNELL PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MCCONNELL PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:989-621-7375
Mailing Address - Street 1:6810 E BEAVERTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9699
Mailing Address - Country:US
Mailing Address - Phone:989-621-7375
Mailing Address - Fax:
Practice Address - Street 1:6810 E BEAVERTON RD
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9699
Practice Address - Country:US
Practice Address - Phone:989-621-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty