Provider Demographics
NPI:1194936633
Name:CONNOLLY, CINDY LYNN (LMT)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:LYNN
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LYNN
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:3096 DERBY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8633
Mailing Address - Country:US
Mailing Address - Phone:630-631-6755
Mailing Address - Fax:
Practice Address - Street 1:3096 DERBY CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-8633
Practice Address - Country:US
Practice Address - Phone:630-631-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227004206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist