Provider Demographics
NPI:1063466779
Name:ARMSTRONG, JENNIFER MULLANE (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MULLANE
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:565 LONG HILL RD
Practice Address - Street 2:STE 3
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4134
Practice Address - Country:US
Practice Address - Phone:860-445-0756
Practice Address - Fax:860-445-7659
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist