Healthcare Provider Details

I. General information

NPI: 1376430702
Provider Name (Legal Business Name): JILL GREGORIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N MAIN ST
WATERBURY CT
06702-1403
US

IV. Provider business mailing address

22 TOMPKINS ST
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 475-305-2700
  • Fax:
Mailing address:
  • Phone: 203-419-0381
  • Fax: 203-419-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number949
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: