Provider Demographics
NPI:1306346911
Name:ELIES, ABIGAIL MARIE (ATC/LAT)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:MARIE
Last Name:ELIES
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 W 28TH CT UNIT 202
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5109
Mailing Address - Country:US
Mailing Address - Phone:407-435-1172
Mailing Address - Fax:
Practice Address - Street 1:11100 NW 27TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5001
Practice Address - Country:US
Practice Address - Phone:407-435-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL35312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer