Provider Demographics
NPI:1619639747
Name:MANDELBLATT, ABIGAIL E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:E
Last Name:MANDELBLATT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WYNDHURST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2424
Mailing Address - Country:US
Mailing Address - Phone:410-601-3991
Mailing Address - Fax:
Practice Address - Street 1:600 WYNDHURST AVE STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2424
Practice Address - Country:US
Practice Address - Phone:410-601-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2022-12-04
Deactivation Date:2022-11-21
Deactivation Code:
Reactivation Date:2022-12-02
Provider Licenses
StateLicense IDTaxonomies
MD29223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist