Look up the most recent NPI and PECOS records

Kevin M Connellan

Physical Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

97 Barnes Rd, Wallingford, CT 06492-1885

PECOS Enrollment

Based on the most recent information from CMS, provider Kevin M Connellan does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1962500504
Provider Type
Individual
Full Name
Connellan, Kevin M
Title
Mr.
Credential
PT

Gender
Male
Sole Proprietor
No
Enumeration Date
9/20/2006
Last Updated
7/24/2015

Contact Information

Practice Location

97 Barnes Rd, Wallingford, CT 06492-1885

(203) 793-7592

(203) 793-7397

Mailing Location

47 N Main St, West Hartford, CT 06107-1926

(860) 409-4595

(860) 409-4860

Provider Taxonomies

Code	Description	License
Code 225100000X Primary	Description Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 7235 Connecticut

Provider Identifiers

ID	Description	Issuer
ID 007235	Description Other	Issuer STATE LICENSE Connecticut

Kevin M Connellan

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Faulkner, Joan C

Tudini, Frank Thomas

Alves, Taylor

Metaxas, Nicholas

Fisk, Elizabeth Ann

Connecticut Orthopaedic Specialists, Pc

Ridnert, Kristina

Wenzel, Derek

Tighe, Ashley

Prohealth Physicians Physical Therapy