| Doctor Name: | MR. JEREMY VIGNEAULT |
| NPI Number: | 1790885986 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 007683 |
| Business Practice Address: | 843 Bolton Rd U-1249 Storrs, CT - 062691249 |
| Business Phone Number: | 8604868080 |
| Business Fax Number: | 8604868081 |
| Mailing Address: | 843 Bolton Rd, U-1249 STORRS |
| State: | CT |
| Postal Code: | 062691249 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2006 |
| NPI Last Update Date: | 03/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 007683 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |