Provider Demographics
NPI:1962533836
Name:SARGENT, JEFFREY MICHAEL (ATC,CSCS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:SARGENT
Suffix:
Gender:M
Credentials:ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3031
Mailing Address - Country:US
Mailing Address - Phone:860-741-5984
Mailing Address - Fax:
Practice Address - Street 1:181 PATRICIA M GENOVA DR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1500
Practice Address - Country:US
Practice Address - Phone:860-667-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer