Healthcare Provider Details

I. General information

NPI: 1730855560
Provider Name (Legal Business Name): ABIGAIL NICOLE NIEBLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OLYMPIC PLZ
COLORADO SPRINGS CO
80909-5780
US

IV. Provider business mailing address

12 RICE HOPE CT
BLUFFTON SC
29909-3113
US

V. Phone/Fax

Practice location:
  • Phone: 719-332-8815
  • Fax:
Mailing address:
  • Phone: 908-328-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0002946
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: