Healthcare Provider Details

I. General information

NPI: 1639056294
Provider Name (Legal Business Name): JUSTINA COURGI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 MAIN ST S STE 5
SOUTHBURY CT
06488-2387
US

IV. Provider business mailing address

22 TOMPKINS ST
WATERBURY CT
06708-1458
US

V. Phone/Fax

Practice location:
  • Phone: 203-267-4060
  • Fax: 203-267-4065
Mailing address:
  • Phone: 203-419-0381
  • Fax: 203-419-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15064
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: