Provider Demographics
NPI:1528283165
Name:CONNOLLY, CHRISTINE (PT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PRON
Other - Middle Name:C
Other - Last Name:PRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:96 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1801
Mailing Address - Country:US
Mailing Address - Phone:973-379-8400
Mailing Address - Fax:973-451-0246
Practice Address - Street 1:33 BLEEKER ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1459
Practice Address - Country:US
Practice Address - Phone:973-379-8400
Practice Address - Fax:973-379-8484
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00789100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist