Healthcare Provider Details

I. General information

NPI: 1518574763
Provider Name (Legal Business Name): JENIFER HARDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 DANBURY RD
WILTON CT
06897-2006
US

IV. Provider business mailing address

439 DANBURY RD
WILTON CT
06897-2006
US

V. Phone/Fax

Practice location:
  • Phone: 203-834-0199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number006315
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: