Provider Demographics
NPI:1215647979
Name:ABBOTT, ASHLEY ADELL (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ADELL
Last Name:ABBOTT
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 1:1300 GEMINI ST APT 2305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-6017
Mailing Address - Country:US
Mailing Address - Phone:361-548-7924
Mailing Address - Fax:
Practice Address - Street 1:1300 GEMINI ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-6014
Practice Address - Country:US
Practice Address - Phone:361-548-7924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13649602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic