Provider Demographics
NPI:1710221502
Name:MCCONNELL, CATHY MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:MICHELLE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:MICHELLE
Other - Last Name:WHITEWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:2744 ASHERS FORK DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4943
Practice Address - Country:US
Practice Address - Phone:615-603-7690
Practice Address - Fax:615-603-7690
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist