Healthcare Provider Details

I. General information

NPI: 1467567651
Provider Name (Legal Business Name): TAMMY ABENDROTH LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E MAIN ST
OLNEY IL
62450-2623
US

IV. Provider business mailing address

905 E MAIN ST
OLNEY IL
62450-2623
US

V. Phone/Fax

Practice location:
  • Phone: 618-393-7732
  • Fax: 618-395-3123
Mailing address:
  • Phone: 618-393-7732
  • Fax: 618-395-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160003708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: