Provider Demographics
NPI:1184031106
Name:ABEJAR, ADELIE BELLE
Entity Type:Individual
Prefix:
First Name:ADELIE BELLE
Middle Name:
Last Name:ABEJAR
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 1:8610 57TH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4855
Mailing Address - Country:US
Mailing Address - Phone:570-269-3371
Mailing Address - Fax:
Practice Address - Street 1:8610 57TH RD STE 1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4855
Practice Address - Country:US
Practice Address - Phone:570-269-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021109225100000X
NY29211-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist