Provider Demographics
NPI:1588748081
Name:ABADIE, CHARLIE WILFRED (PT)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:WILFRED
Last Name:ABADIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29269
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592
Mailing Address - Country:US
Mailing Address - Phone:505-984-2032
Mailing Address - Fax:505-474-8836
Practice Address - Street 1:6320 RIVERSIDE PLAZA LN
Practice Address - Street 2:STE 150B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-884-2032
Practice Address - Fax:505-553-7300
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist