Provider Demographics
NPI:1588852057
Name:CONNOLLY, MARY ANN (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 KING GEORGE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2817
Mailing Address - Country:US
Mailing Address - Phone:908-903-1901
Mailing Address - Fax:908-903-1902
Practice Address - Street 1:413 KING GEORGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2817
Practice Address - Country:US
Practice Address - Phone:908-903-1901
Practice Address - Fax:908-903-1902
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00903600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist