MEDICARE: LUZ MARINA CONNOLLY P.T.

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	024847-1	NY
2	225100000X	Physical Therapist	1225527	TX

General Provider Information

NPI Number	:	1770536328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ MARINA CONNOLLY P.T.

Provider Business Mailing Address
First Line	:	6360 W SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-5164
Country	:	US
Telephone Number	:	832-302-7354
Fax Number	:

Provider Business Practice Location Address
First Line	:	6360 W SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-5164
Country	:	US
Telephone Number	:	832-302-7354
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/09/2015

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