Individual
JENNIFER MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20 NORTH ST APT 11-2, STAMFORD, CT 06902-2363
(203) 962-5102
Mailing address
20 NORTH ST APT 11-2, STAMFORD, CT 06902-2363
(203) 962-5102
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/14/2024
Last updated
05/14/2024
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