Provider Demographics
NPI:1477042836
Name:MIRABELLI, ABIGAIL C (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:C
Last Name:MIRABELLI
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:LOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 RAVINE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 RAVINE WAY STE 100
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7645
Practice Address - Country:US
Practice Address - Phone:309-267-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL390200000XOtherSTUDENT