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General NPI Number Information
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NPI Number | 1144863994
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Entity Type | Individual
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Provider Name | CECILY EVAN FONTENOT ABERNATHY PTA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 1215 CHESNUT BYP STE B
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City | CENTRE
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State | AL
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Zip | 35960-2830
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Country | US
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Telephone | 256-266-1001
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Fax | 256-266-1071
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Provider Business Mailing Address
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Address Line | 8205 PRESIDENTS DR
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City | HUMMELSTOWN
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State | PA
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Zip | 17036-8621
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Country | US
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Telephone | 717-839-2159
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Fax | 717-565-1104
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA9599
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License Number State | AL
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