Healthcare Provider Details

I. General information

NPI: 1215202007
Provider Name (Legal Business Name): ABBY N PINGEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WALNUT ST
NORTH BEND NE
68649-5012
US

IV. Provider business mailing address

422 11TH AVE W
SPENCER IA
51301-3041
US

V. Phone/Fax

Practice location:
  • Phone: 402-216-0315
  • Fax:
Mailing address:
  • Phone: 712-363-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1083
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number004853
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: