Healthcare Provider Details

I. General information

NPI: 1568963874
Provider Name (Legal Business Name): ALEXANDER CONNOLLY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 HARBOUR PARK DR
MIDLOTHIAN VA
23112-2163
US

IV. Provider business mailing address

21600 OXNARD ST STE 1800
WOODLAND HILLS CA
91367-7807
US

V. Phone/Fax

Practice location:
  • Phone: 804-293-8055
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number119009661
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: