Healthcare Provider Details

I. General information

NPI: 1356109565
Provider Name (Legal Business Name): ABIGAIL ROSE EAVES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 SPRUCE ST STE 105
PHILADELPHIA PA
19107-5752
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 215-383-1620
  • Fax: 215-383-1621
Mailing address:
  • Phone: 856-677-4000
  • Fax: 812-590-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02240600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT032136
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: