Healthcare Provider Details

I. General information

NPI: 1558974352
Provider Name (Legal Business Name): MCCONNELL PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 E BEAVERTON RD
CLARE MI
48617-9699
US

IV. Provider business mailing address

6810 E BEAVERTON RD
CLARE MI
48617-9699
US

V. Phone/Fax

Practice location:
  • Phone: 989-621-7375
  • Fax:
Mailing address:
  • Phone: 989-621-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA MCCONNELL
Title or Position: OWNER/THERAPIST
Credential: DPT
Phone: 989-621-7375