Provider Demographics
NPI:1245738970
Name:ABBOTT, DAVID (NMT HMS SMT LMT TIC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:NMT HMS SMT LMT TIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 ACADEMY CIR STE F
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1674
Mailing Address - Country:US
Mailing Address - Phone:719-373-3399
Mailing Address - Fax:
Practice Address - Street 1:2120 ACADEMY CIR STE F
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1674
Practice Address - Country:US
Practice Address - Phone:719-373-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
COMT.0019317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO708340OtherAVAILITY