Provider Demographics
NPI:1326674219
Name:CONNAUGHTON, BRYAN CHRISTOPHER (DPT)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:CHRISTOPHER
Last Name:CONNAUGHTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12 COPPERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1049
Practice Address - Country:US
Practice Address - Phone:973-285-7613
Practice Address - Fax:973-267-1716
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5564225100000X
NJ40QA01951600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist