Provider Demographics
NPI:1518503978
Name:FAJARDO, ELIXIR JON GABRIEL PELEGRIN (PT, DPT, RAC-CT)
Entity Type:Individual
Prefix:DR
First Name:ELIXIR JON GABRIEL
Middle Name:PELEGRIN
Last Name:FAJARDO
Suffix:
Gender:M
Credentials:PT, DPT, RAC-CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WASHINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 WASHINGTON CIR
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3020
Practice Address - Country:US
Practice Address - Phone:347-633-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist