Healthcare Provider Details

I. General information

NPI: 1326017310
Provider Name (Legal Business Name): STEPHEN CONNOLLY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 25TH AVE N STE 520
NASHVILLE TN
37203-1675
US

IV. Provider business mailing address

800 CRESCENT CENTRE DR STE 300
FRANKLIN TN
37067-7285
US

V. Phone/Fax

Practice location:
  • Phone: 615-321-3215
  • Fax: 615-321-3216
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-221-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4784
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: