Provider Demographics
NPI:1588447502
Name:CLIST, ABIGAIL (PT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:CLIST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:HUGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W9187 HIDDEN VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-9047
Mailing Address - Country:US
Mailing Address - Phone:608-698-3020
Mailing Address - Fax:
Practice Address - Street 1:7 CARNEGIE PLZ
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1000
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16508-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist