Healthcare Provider Details

I. General information

NPI: 1295551307
Provider Name (Legal Business Name): ABBY TRAXLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E 8TH ST
DAVIS CA
95616-2502
US

IV. Provider business mailing address

2875 291ST AVE
MADISON MN
56256-3296
US

V. Phone/Fax

Practice location:
  • Phone: 530-756-1800
  • Fax:
Mailing address:
  • Phone: 320-413-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: