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NPI Code Detail

MEDICARE: ANDREW ABBOTT

MEDICARE:   ANDREW  ABBOTT
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
1225100000XPhysical TherapistPT42459FL

General Provider Information

NPI Number : 1073320032
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW ABBOTT
Provider Business Mailing Address
First Line : 21756 STATE ROAD 54 STE 102
Second Line :
City : LUTZ
State : FL
Zip : 33549-2905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2600 DR MARTIN LUTHER KING JR ST N STE 200B
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33704-2744
Country : US
Telephone Number : 727-202-4625
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2024
Last Update Date : 12/13/2024

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