Provider Demographics
NPI:1154939726
Name:SHEW-A-TJON, ABIGAIL ASHLEY R
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ASHLEY R
Last Name:SHEW-A-TJON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2761 SW ENSENADA TER
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4153
Mailing Address - Country:US
Mailing Address - Phone:772-634-4676
Mailing Address - Fax:
Practice Address - Street 1:2761 SW ENSENADA TER
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4153
Practice Address - Country:US
Practice Address - Phone:772-634-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA30342225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty