Provider Demographics
NPI:1497455026
Name:BLACK, ABIGAIL ROGERS
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ROGERS
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 TYLER LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2633
Mailing Address - Country:US
Mailing Address - Phone:502-718-7295
Mailing Address - Fax:
Practice Address - Street 1:2228 TYLER LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2633
Practice Address - Country:US
Practice Address - Phone:502-718-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist