MEDICARE: MATTHEW CONNELL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	007650	CT

General Provider Information

NPI Number	:	1538217658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CONNELL PT

Provider Business Mailing Address
First Line	:	135 MIDDLE ST
Second Line	:	UNIT B
City	:	BRISTOL
State	:	CT
Zip	:	06010-7404
Country	:	US
Telephone Number	:	860-585-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 MIDDLE ST
Second Line	:	UNIT B
City	:	BRISTOL
State	:	CT
Zip	:	06010-7404
Country	:	US
Telephone Number	:	860-585-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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Directions to “ MATTHEW CONNELL PT” Practice Location

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