Provider Demographics
NPI:1093329070
Name:DAUTERMAN, ABBIGAIL ANN
Entity Type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:ANN
Last Name:DAUTERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 TOWNSHIP ROAD 293
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-9641
Mailing Address - Country:US
Mailing Address - Phone:419-420-5181
Mailing Address - Fax:
Practice Address - Street 1:725 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-3255
Practice Address - Country:US
Practice Address - Phone:419-937-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018862225100000X
IN05013939A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist