Provider Demographics
NPI:1619066479
Name:CONNELLY, VICTORIA ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:8530 DOAR RD
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-6037
Mailing Address - Country:US
Mailing Address - Phone:843-884-4783
Mailing Address - Fax:843-884-4783
Practice Address - Street 1:570 LONG POINT RD
Practice Address - Street 2:SUITE 270
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:24946
Practice Address - Country:US
Practice Address - Phone:843-884-4783
Practice Address - Fax:843-884-4783
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist