Healthcare Provider Details

I. General information

NPI: 1700616455
Provider Name (Legal Business Name): ABIGAIL LIM-ZAJAC PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL LIM PTA

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE STE 135
MODESTO CA
95350-4569
US

IV. Provider business mailing address

3416 WOODBINE DR
MODESTO CA
95355-4837
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-5801
  • Fax:
Mailing address:
  • Phone: 916-585-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number48847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: