Provider Demographics
NPI:1700887999
Name:CONNOLLY, ERIC MICHAEL (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MICHAEL
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:670 LINWOOD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-2068
Mailing Address - Country:US
Mailing Address - Phone:508-234-7544
Mailing Address - Fax:508-234-8002
Practice Address - Street 1:670 LINWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-2068
Practice Address - Country:US
Practice Address - Phone:508-234-7544
Practice Address - Fax:508-234-8002
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA12189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6404497OtherUNITED HEALTHCARE
MAY68122OtherBLUE CROSS BLUE SHIELD
MA470091OtherTUFTS
MA470091OtherTUFTS