Healthcare Provider Details

I. General information

NPI: 1134416233
Provider Name (Legal Business Name): ABIGAIL L. EDWARDS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL L. WAY PT

II. Dates (important events)

Enumeration Date: 07/09/2011
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 N STATE ST
GREENFIELD IN
46140-1066
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 317-467-5700
  • Fax: 317-467-5701
Mailing address:
  • Phone: 630-575-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13239
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011132A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: