Individual
MARY CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8230 HAZELBRAND RD NE STE A, COVINGTON, GA 30014-1519
(770) 788-7034
Mailing address
PO BOX 83220, CONYERS, GA 30013-8017
(770) 833-9322
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1170313
TX
225100000X
Physical Therapist
Primary
2855
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2855
PT LICENSE
GA
Enumeration date
05/08/2007
Last updated
03/12/2011
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