Individual
JENALYN D VERGARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
186 JERRY BROWNE RD, MYSTIC, CT 06355-4004
(860) 572-5675
Mailing address
29 ENSIGN DR, MYSTIC, CT 06355-1530
(631) 882-5464
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
008043
CT
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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