Provider Demographics
NPI:1205436391
Name:CONNELLY, CLARE (PTA)
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1802
Mailing Address - Country:US
Mailing Address - Phone:508-801-1285
Mailing Address - Fax:
Practice Address - Street 1:85 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1634
Practice Address - Country:US
Practice Address - Phone:508-669-2740
Practice Address - Fax:508-699-0481
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9425225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty