Healthcare Provider Details

I. General information

NPI: 1508775115
Provider Name (Legal Business Name): ABIGAIL JOYCE TERRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JANE LACEY DR APT B-1
ENDICOTT NY
13760-3709
US

IV. Provider business mailing address

1 JANE LACEY DR APT B-1
ENDICOTT NY
13760-3709
US

V. Phone/Fax

Practice location:
  • Phone: 518-610-0904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055920
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: