Provider Demographics
NPI:1154536050
Name:CAMPBELL-CONNOLLY, NANCE L (LPTA)
Entity type:Individual
Prefix:MS
First Name:NANCE
Middle Name:L
Last Name:CAMPBELL-CONNOLLY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 AVONDALE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5515
Mailing Address - Country:US
Mailing Address - Phone:610-853-0846
Mailing Address - Fax:
Practice Address - Street 1:773 E HAVERFORD RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3837
Practice Address - Country:US
Practice Address - Phone:610-525-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE0000152-L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant