Healthcare Provider Details

I. General information

NPI: 1780678987
Provider Name (Legal Business Name): AGNES R ABELLA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SKYLINE DR STE B
MAYNARDVILLE TN
37807-3063
US

IV. Provider business mailing address

PO BOX 71121
KNOXVILLE TN
37938-1121
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-6933
  • Fax: 865-992-6870
Mailing address:
  • Phone: 865-992-6933
  • Fax: 865-992-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000003292
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: