Provider Demographics
NPI:1952935611
Name:CONNELL, COURTNEY GEORGE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GEORGE
Last Name:CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BAY ST
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-3000
Mailing Address - Country:US
Mailing Address - Phone:205-259-3991
Mailing Address - Fax:205-876-8063
Practice Address - Street 1:2030 LAY DAM RD
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-8344
Practice Address - Country:US
Practice Address - Phone:205-755-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty