Healthcare Provider Details

I. General information

NPI: 1427148592
Provider Name (Legal Business Name): ABIGAIL LEIGH WEBER LAT, ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL LEIGH BAUD A.T.C.

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 11TH CT STE 302
VERO BEACH FL
32960-5012
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 170
PALM BEACH GARDENS FL
33410-4549
US

V. Phone/Fax

Practice location:
  • Phone: 772-794-1444
  • Fax:
Mailing address:
  • Phone: 615-627-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number090402193
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1984
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number21-0423
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number6142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: