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General NPI Number Information
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NPI Number | 1639855075
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Entity Type | Individual
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Provider Name | ABIGAIL CLAIRE WILD DPT
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Gender | Female
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 23415 THREE NOTCH RD STE 2026
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City | CALIFORNIA
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State | MD
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Zip | 20619-4021
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Country | US
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Telephone | 240-530-8188
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Fax | 240-237-8572
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Provider Business Mailing Address
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Address Line | 2635 4TH ST SE APT 1110
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-3869
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Country | US
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Telephone | 434-249-8823
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13171
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30282
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License Number State | MD
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