Provider Demographics
NPI:1063610913
Name:ABBOTT, ABIGAIL T (PT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:T
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:VT
Mailing Address - Zip Code:05343-9761
Mailing Address - Country:US
Mailing Address - Phone:802-874-4873
Mailing Address - Fax:802-874-7222
Practice Address - Street 1:8 GILL TER
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:VT
Practice Address - Zip Code:05149-1004
Practice Address - Country:US
Practice Address - Phone:802-228-4571
Practice Address - Fax:802-228-4571
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist