Healthcare Provider Details

I. General information

NPI: 1174835193
Provider Name (Legal Business Name): LAURA BANDY ABELL PT, DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 E MAIN ST UNIT 1
LEBANON KY
40033-8696
US

IV. Provider business mailing address

703 E MAIN ST UNIT 1
LEBANON KY
40033-8696
US

V. Phone/Fax

Practice location:
  • Phone: 270-699-9503
  • Fax:
Mailing address:
  • Phone: 270-699-9503
  • Fax: 270-699-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-005632
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number005632
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: