Provider Demographics
NPI:1407195852
Name:ISMATH, ABIGAIL S (LMT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:S
Last Name:ISMATH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:S
Other - Last Name:CROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1126 SE TAMORA AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4781
Mailing Address - Country:US
Mailing Address - Phone:503-330-9022
Mailing Address - Fax:
Practice Address - Street 1:7177 NE IMBRIE DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7594
Practice Address - Country:US
Practice Address - Phone:503-648-7662
Practice Address - Fax:503-966-7954
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18730225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist