Individual
TARA DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
465 WOLCOTT RD, ADVANCED PHYSICAL THERAPY, WOLCOTT, CT 06716-2613
(203) 897-0107
(203) 879-0206
Mailing address
96 SILVER OAK CIR, SOUTHINGTON, CT 06489-4665
(203) 578-0409
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
007482
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007482
CT LICENSE
CT
Enumeration date
08/17/2011
Last updated
08/17/2011
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