Provider Demographics
NPI:1407026875
Name:FORTICH, ABIGAIL GUIRNELA (RPT)
Entity Type:Individual
Prefix:MISS
First Name:ABIGAIL
Middle Name:GUIRNELA
Last Name:FORTICH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W 5TH ST
Mailing Address - Street 2:SUITE D AND E
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2501
Mailing Address - Country:US
Mailing Address - Phone:646-207-7869
Mailing Address - Fax:
Practice Address - Street 1:105 PLAZA DR
Practice Address - Street 2:APT F
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5136
Practice Address - Country:US
Practice Address - Phone:646-207-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-02
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist