Provider Demographics
NPI:1871772533
Name:ERNST, CONNIE M (NCTMB, CIMI)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:M
Last Name:ERNST
Suffix:
Gender:F
Credentials:NCTMB, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SHERRY DR
Mailing Address - Street 2:
Mailing Address - City:MCSHERRYSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17344-1107
Mailing Address - Country:US
Mailing Address - Phone:717-632-7001
Mailing Address - Fax:
Practice Address - Street 1:113 SHERRY DR
Practice Address - Street 2:
Practice Address - City:MCSHERRYSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17344-1107
Practice Address - Country:US
Practice Address - Phone:717-632-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
333657-00OtherNCBTMB
863016OtherABMP
C16477OtherIAIM REGISTRATION