MEDICARE: ABIGAIL NIERSBACH SHIOTELIS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT016542	GA

General Provider Information

NPI Number	:	1235821117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL NIERSBACH SHIOTELIS PT, DPT

Provider Business Mailing Address
First Line	:	3450 BLAIR CIR NE UNIT 5113
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-2270
Country	:	US
Telephone Number	:	770-331-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 JOHNS CREEK PKWY
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-6091
Country	:	US
Telephone Number	:	770-738-9657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	06/14/2026

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