Individual
JACQUELINE CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
380 WASHINGTON AVE, ROOSEVELT, NY 11575-1845
(516) 378-2000
Mailing address
21908 43RD AVE, BAYSIDE, NY 11361-3523
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
002872
NY
Other
Enumeration date
03/26/2007
Last updated
07/14/2016
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