Provider Demographics
NPI:1134276553
Name:CONNOLLY, MICHELE CATHERINE (MHS,PT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:CATHERINE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MHS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HICKORY CORNER RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1220
Mailing Address - Country:US
Mailing Address - Phone:609-426-4798
Mailing Address - Fax:
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3030
Practice Address - Country:US
Practice Address - Phone:609-275-0666
Practice Address - Fax:609-275-8004
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00476900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ924946OtherAETNA PROVIDER NUMBER
NJ924946OtherAETNA PROVIDER NUMBER