Provider Demographics
NPI:1609093731
Name:PAGNAMENTA, JENNIFER (RPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PAGNAMENTA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COWLES RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-1726
Mailing Address - Country:US
Mailing Address - Phone:203-263-3104
Mailing Address - Fax:203-263-4050
Practice Address - Street 1:51 SHERMAN HILL RD STE A201
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3694
Practice Address - Country:US
Practice Address - Phone:203-263-3104
Practice Address - Fax:203-263-4050
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006100OtherPHYSICAL THERAPY LICENSE