MEDICARE: MISS ABBY LEIGH BAALMAN D.P.T.

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	070-023521	IL
2	225100000X	Physical Therapist	070.023521	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070.023521	OTHER	IL	PROFESSIONAL LICENSE

General Provider Information

NPI Number	:	1174025506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ABBY LEIGH BAALMAN D.P.T.

Provider Business Mailing Address
First Line	:	1719 CLAWSON STREET
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002
Country	:	US
Telephone Number	:	618-462-1133
Fax Number	:	618-462-3736

Provider Business Practice Location Address
First Line	:	314 5TH ST
Second Line	:
City	:	CARROLLTON
State	:	IL
Zip	:	62016-1325
Country	:	US
Telephone Number	:	217-409-6405
Fax Number	:	217-305-7282

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

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	10/12/2020

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