Provider Demographics
NPI:1235821117
Name:NIERSBACH, ABIGAIL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:NIERSBACH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4742 TERQUAY CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7522
Mailing Address - Country:US
Mailing Address - Phone:770-331-0702
Mailing Address - Fax:
Practice Address - Street 1:4310 JOHNS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6091
Practice Address - Country:US
Practice Address - Phone:770-738-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist