Individual
MR. STEPHEN J CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2516 E. DUPONT RD, FORT WAYNE, IN 46825-2097
(260) 490-4800
(260) 497-8399
Mailing address
4251 LAHMEYER RD, FORT WAYNE, IN 46815-5676
(260) 432-4700
(260) 459-9262
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05005430A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000197330
ANTHEM BCBS
IN
01
—
1424
PHP
IN
01
—
156546
MEDICARE
IN
05
—
200362960A
—
IN
01
—
4423623
AETNA
IN
01
—
N235814
HARMONY
IN
Enumeration date
11/27/2006
Last updated
04/08/2010
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