Provider Demographics
NPI:1770536328
Name:CONNOLLY, LUZ MARINA (PT)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARINA
Last Name:CONNOLLY
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 1:6360 W SAM HOUSTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5164
Mailing Address - Country:US
Mailing Address - Phone:832-302-7354
Mailing Address - Fax:
Practice Address - Street 1:6360 W SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5164
Practice Address - Country:US
Practice Address - Phone:832-302-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024847-1225100000X
TX1225527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist