Provider Demographics
NPI:1598436875
Name:FILLEY, ABIGAIL ELYSE (PTA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELYSE
Last Name:FILLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S US HIGHWAY 169
Mailing Address - Street 2:
Mailing Address - City:GOWER
Mailing Address - State:MO
Mailing Address - Zip Code:64454-9116
Mailing Address - Country:US
Mailing Address - Phone:816-424-6483
Mailing Address - Fax:
Practice Address - Street 1:323 S US HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:GOWER
Practice Address - State:MO
Practice Address - Zip Code:64454-9116
Practice Address - Country:US
Practice Address - Phone:816-424-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03872225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant