Individual
JEREMY GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
50 BEACH RD, WOLCOTT, CT 06716-1902
(203) 879-8066
(203) 879-8484
Mailing address
50 BEACH RD, WOLCOTT, CT 06716-1902
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006374
CT
Other
Enumeration date
07/24/2012
Last updated
07/24/2012
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