Provider Demographics
NPI:1902029051
Name:CONNELLEY, KAREN MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MICHELLE
Last Name:CONNELLEY
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 1:1200 OLD WARREN ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-9304
Mailing Address - Country:US
Mailing Address - Phone:870-367-1548
Mailing Address - Fax:870-367-1383
Practice Address - Street 1:1200 OLD WARREN ROAD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-9304
Practice Address - Country:US
Practice Address - Phone:870-367-1548
Practice Address - Fax:870-367-1383
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123307721Medicaid