Provider Demographics
NPI:1801653233
Name:CONNOLLY, SEAN CHRISTOPHER (DPT, PT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:CHRISTOPHER
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BLAKE ST APT 2105
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-4411
Mailing Address - Country:US
Mailing Address - Phone:203-909-0847
Mailing Address - Fax:
Practice Address - Street 1:30 CONTROLS DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6157
Practice Address - Country:US
Practice Address - Phone:203-513-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist