Healthcare Provider Details

I. General information

NPI: 1255618435
Provider Name (Legal Business Name): ANDREW J ABBOTT MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7478 SW 60TH AVE UNIT A
OCALA FL
34476-6428
US

IV. Provider business mailing address

7478 SW 60TH AVE UNIT A
OCALA FL
34476-6428
US

V. Phone/Fax

Practice location:
  • Phone: 352-433-1918
  • Fax: 352-433-0950
Mailing address:
  • Phone: 352-433-1918
  • Fax: 352-433-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT14651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: