MEDICARE: ANGELA MARIE ABRAHAM 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	PT017438	GA

General Provider Information

NPI Number	:	1952120289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE ABRAHAM DPT

Provider Business Mailing Address
First Line	:	2383 AKERS MILL RD SE APT N16
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2528
Country	:	US
Telephone Number	:	630-800-9202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1995 N PARK PL SE STE 410
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2072
Country	:	US
Telephone Number	:	770-850-0390
Fax Number	:	770-818-9726

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

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	10/18/2024

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