Provider Demographics
NPI:1134463557
Name:FORTUNE, ABIGAIL (DPT)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 KENT AVE
Mailing Address - Street 2:B3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4462
Mailing Address - Country:US
Mailing Address - Phone:646-234-7172
Mailing Address - Fax:
Practice Address - Street 1:965 KENT AVE
Practice Address - Street 2:B3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4462
Practice Address - Country:US
Practice Address - Phone:646-234-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035690-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist