=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235350455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIGAIL LOUISE HANSBERGER VATL, ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 04/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 RAM DR
-----------------------------------------------------
City | STRASBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22657-2246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-465-5195
-----------------------------------------------------
Fax | 540-465-5461
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 5TH ST
-----------------------------------------------------
City | TIMBERVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22853-9519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-896-2947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 0126001093
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------