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General NPI Number Information
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NPI Number | 1871479394
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Entity Type | Individual
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Provider Name | JESSICA CONVERY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 249 DANBURY RD
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City | WILTON
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State | CT
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Zip | 06897-4070
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Country | US
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Telephone | 203-869-1145
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Fax |
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Provider Business Mailing Address
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Address Line | 100 LANE 201A LAKE GEORGE
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City | FREMONT
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State | IN
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Zip | 46737-8949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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