Provider Demographics
NPI:1790089092
Name:CALLARD, CONNIE J (CCWFN, LMT, CPP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:J
Last Name:CALLARD
Suffix:
Gender:F
Credentials:CCWFN, LMT, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-3600
Mailing Address - Country:US
Mailing Address - Phone:508-429-3491
Mailing Address - Fax:
Practice Address - Street 1:838 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-3600
Practice Address - Country:US
Practice Address - Phone:508-429-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2268172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist