Provider Demographics
NPI:1720570385
Name:CONNELLY, TIMOTHY JACOB (RBT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JACOB
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 PRESIDIO WAY
Mailing Address - Street 2:
Mailing Address - City:PLUMAS LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95961-9071
Mailing Address - Country:US
Mailing Address - Phone:916-829-6975
Mailing Address - Fax:
Practice Address - Street 1:1128 YUBA ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-4831
Practice Address - Country:US
Practice Address - Phone:530-640-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner