Healthcare Provider Details

I. General information

NPI: 1467215947
Provider Name (Legal Business Name): ABIGAIL JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL KIRTLEY

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 BASS PRO DR
SAINT CHARLES MO
63301-2461
US

IV. Provider business mailing address

701 LIBERTY ST
SMITHVILLE MO
64089-9245
US

V. Phone/Fax

Practice location:
  • Phone: 636-757-5075
  • Fax: 636-757-5076
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2024004733
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP035656T
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: