Healthcare Provider Details

I. General information

NPI: 1194670976
Provider Name (Legal Business Name): JESSE FLEMING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FEDERAL RD STE 100
BROOKFIELD CT
06804-2505
US

IV. Provider business mailing address

200 BLOOMFIELD AVE
WEST HARTFORD CT
06117-1599
US

V. Phone/Fax

Practice location:
  • Phone: 203-456-1010
  • Fax:
Mailing address:
  • Phone: 203-733-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15613
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: