Provider Demographics
NPI:1306486055
Name:PEABODY, ABIGAIL D (PTA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:D
Last Name:PEABODY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9592 CORDOVA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-3787
Mailing Address - Country:US
Mailing Address - Phone:574-527-8610
Mailing Address - Fax:
Practice Address - Street 1:12919 STROH RANCH CT UNIT F
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7709
Practice Address - Country:US
Practice Address - Phone:303-841-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0013268225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant