1124036322 NPI number — MS. ABBY L CURTIS PT, MS, CLT

Table of content: MS. ABBY L CURTIS PT, MS, CLT (NPI 1124036322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124036322 NPI number — MS. ABBY L CURTIS PT, MS, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CURTIS
Provider First Name:
ABBY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, MS, CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLT
Provider Other First Name:
ABBY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, MS, CLT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124036322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 TRINITY LANE
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61704-3738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-663-6461
Provider Business Mailing Address Fax Number:
309-661-8107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 TRINITY LANE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61704-3738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-663-6461
Provider Business Practice Location Address Fax Number:
309-661-8107
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070014195 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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