Provider Demographics
NPI:1063794063
Name:TEMPLE, ABIGAIL M (DPT)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:M
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 PINEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6553
Mailing Address - Country:US
Mailing Address - Phone:309-716-7789
Mailing Address - Fax:
Practice Address - Street 1:4557 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1641
Practice Address - Country:US
Practice Address - Phone:563-332-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004513225100000X
IL070017703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist