Provider Demographics
NPI:1386222347
Name:ABITBOL, AVIVA N (DPT)
Entity Type:Individual
Prefix:
First Name:AVIVA
Middle Name:N
Last Name:ABITBOL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AVIVA
Other - Middle Name:N
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:836 COOPER LANDING RD APT 210E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1742
Mailing Address - Country:US
Mailing Address - Phone:773-789-5507
Mailing Address - Fax:
Practice Address - Street 1:291 HARDING HWY
Practice Address - Street 2:
Practice Address - City:CARNEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069-2344
Practice Address - Country:US
Practice Address - Phone:856-299-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01968000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist