Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 02-25-2008 | ME |
NPI | 1356505697 |
---|---|
Provider Name | Lisa Ann Connolly |
First Address | Scarborough, ME 04074-8996 |
Second Address | Scarborough, ME 04074-8996 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 16/07/2008 |