Healthcare Provider Details

I. General information

NPI: 1316632664
Provider Name (Legal Business Name): ABIGAIL MARIE WUENSCH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4313
US

IV. Provider business mailing address

6000 CORTADERIA ST NE APT 3122
ALBUQUERQUE NM
87111-8005
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-9478
  • Fax:
Mailing address:
  • Phone: 317-383-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5984
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: