Provider Demographics
NPI:1134607740
Name:JAGGON, LEIGH-ANN DANIELLE (DPT, PT)
Entity type:Individual
Prefix:
First Name:LEIGH-ANN
Middle Name:DANIELLE
Last Name:JAGGON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WEDGEWOOD DR APT B6
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1931
Mailing Address - Country:US
Mailing Address - Phone:860-997-2341
Mailing Address - Fax:
Practice Address - Street 1:35 JOLLEY DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3071
Practice Address - Country:US
Practice Address - Phone:860-242-1578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist