Individual
MR. JOHN O CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBA PT ATC
Contact information
Practice address
1537 E HILL RD, SUITE 400, GRAND BLANC, MI 48439-5127
(810) 603-1100
(810) 603-1101
Mailing address
4466 W BRISTOL RD, FLINT, MI 48507-3170
(810) 733-1200
(810) 733-3130
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501008594
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N45090
GRP MEDICARE PIN
—
01
—
CB0923
GRP RR MEDICARE
—
Enumeration date
02/02/2007
Last updated
12/04/2009
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