MEDICARE: ABBY NICOLE CARMICHAEL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070019279	IL

General Provider Information

NPI Number	:	1033466578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY NICOLE CARMICHAEL PT

Provider Business Mailing Address
First Line	:	503 NORMANDY LN
Second Line	:
City	:	PORT BARRINGTON
State	:	IL
Zip	:	60010-1075
Country	:	US
Telephone Number	:	815-441-2539
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 NORMANDY LN
Second Line	:
City	:	PORT BARRINGTON
State	:	IL
Zip	:	60010-1075
Country	:	US
Telephone Number	:	815-441-2539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	05/15/2020

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