Provider Demographics
NPI:1053560151
Name:CONNELLY, JAMES M (PT, DPT,CSCS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:PT, DPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3231
Mailing Address - Country:US
Mailing Address - Phone:315-282-0067
Mailing Address - Fax:
Practice Address - Street 1:278 GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3231
Practice Address - Country:US
Practice Address - Phone:315-282-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist