| NPI | 1619257466 |
|---|---|
| Former Name | MICHELLE MARIE CONNOLLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 28090) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL1546) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2014-01-29 |