Provider Demographics
NPI:1871096933
Name:AYELET CONNELL WELLNESS LLC
Entity type:Organization
Organization Name:AYELET CONNELL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYELET
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELL-GIAMMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:877-774-7253
Mailing Address - Street 1:25 STANLEY ST APT A3
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1831
Mailing Address - Country:US
Mailing Address - Phone:860-796-7537
Mailing Address - Fax:
Practice Address - Street 1:34 JEROME AVE STE 318
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2463
Practice Address - Country:US
Practice Address - Phone:877-774-7253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006813261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy