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NPI Code Detail

MEDICARE: BRIGETTE MARY MCCONNELL PT

MEDICARE: BRIGETTE MARY MCCONNELL PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1170550TX
2225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115065082OTHERTXCAQH

General Provider Information

NPI Number : 1578152310
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIGETTE MARY MCCONNELL PT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3141 E BROAD ST STE 111
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-6425
Country : US
Telephone Number : 817-435-5248
Fax Number : 817-435-5249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2021
Last Update Date : 02/29/2024

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Directions to “ BRIGETTE MARY MCCONNELL PT” Practice Location

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