Provider Demographics
NPI:1982844932
Name:CONNELLY CALZADILLA, LAUREN A (LMT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:A
Last Name:CONNELLY CALZADILLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7939 CAMERON CAY CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-1303
Mailing Address - Country:US
Mailing Address - Phone:727-847-5825
Mailing Address - Fax:
Practice Address - Street 1:7939 CAMERON CAY CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-1303
Practice Address - Country:US
Practice Address - Phone:727-847-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist