Provider Demographics
NPI:1376588517
Name:GARCIA, ABIGAIL VELASQUEZ (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:VELASQUEZ
Last Name:GARCIA
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 1:7435 W TALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3707
Mailing Address - Country:US
Mailing Address - Phone:773-774-8000
Mailing Address - Fax:773-990-7788
Practice Address - Street 1:7435 W TALCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3707
Practice Address - Country:US
Practice Address - Phone:773-774-8000
Practice Address - Fax:773-990-7788
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363396874OtherGROUP TAX ID NO.
IL1618443OtherBCBS GROUP NO.
IL236963283001Medicaid
IL01634372OtherBCBS GROUP NO.
IL200573902OtherGROUP TAX ID
IL01634372OtherBCBS GROUP NO.
ILK28360Medicare PIN
IL363396874OtherGROUP TAX ID NO.
IL236963283001Medicaid