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General NPI Number Information
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NPI Number | 1750550513
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Entity Type | Individual
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Provider Name | MARY ELLEN LECLAIR CONNELLY PT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 2 SOUTH 173 LLOYD
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-212-3419
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Fax | 630-916-0941
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Provider Business Mailing Address
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Address Line | 2 SOUTH 173 LLOYD
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-212-3419
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Fax | 630-916-0941
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 070.004645
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License Number State | IL
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