Individual
MR. MICHAEL MONGCOPA VERGARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1145 POQUONNOCK RD, GROTON, CT 06340-4620
(860) 449-0289
Mailing address
74 LAURELWOOD RD, GROTON, CT 06340-4206
(860) 326-5729
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0007361
CT
Other
Enumeration date
04/09/2012
Last updated
04/09/2012
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