Healthcare Provider Details

I. General information

NPI: 1053068759
Provider Name (Legal Business Name): ABIGAIL SHORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL REILLY

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SPENCER RD STE D
SAINT PETERS MO
63376-2438
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 636-477-9911
  • Fax: 636-477-9929
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2022004180
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070025743
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: