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General NPI Number Information
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NPI Number | 1104641729
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Entity Type | Individual
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Provider Name | ANNA CONNOLLEY
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Gender | Female
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2510 W HUDSON RD
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City | ROGERS
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State | AR
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Zip | 72756-2072
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Country | US
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Telephone | 479-936-3061
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Fax |
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Provider Business Mailing Address
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Address Line | 18442 MARSHALL ST
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City | GARFIELD
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State | AR
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Zip | 72732-8714
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 4957
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License Number State | AR
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