Provider Demographics
NPI:1588207385
Name:CONNORS, MICAELA R (DPT)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:R
Last Name:CONNORS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 H F BROWN WAY
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3889
Mailing Address - Country:US
Mailing Address - Phone:508-647-1633
Mailing Address - Fax:508-647-1634
Practice Address - Street 1:1 H F BROWN WAY
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3889
Practice Address - Country:US
Practice Address - Phone:508-647-1633
Practice Address - Fax:508-647-1634
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA24518OtherSTATE LICENSE