Provider Demographics
NPI:1023095106
Name:FEGAN, MARY JANE (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:
Last Name:FEGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY JANE
Other - Middle Name:
Other - Last Name:ZYSKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:753 BOSTON POST RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2749
Mailing Address - Country:US
Mailing Address - Phone:203-458-6268
Mailing Address - Fax:
Practice Address - Street 1:753 BOSTON POST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2749
Practice Address - Country:US
Practice Address - Phone:203-458-6268
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist