Provider Demographics
NPI:1295203974
Name:ABEL, ALEXANDRIA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:ABEL
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 1:74 GERRITSEN AVE
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-2118
Mailing Address - Country:US
Mailing Address - Phone:631-655-7856
Mailing Address - Fax:
Practice Address - Street 1:74 GERRITSEN AVE
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-2118
Practice Address - Country:US
Practice Address - Phone:631-655-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist