Provider Demographics
NPI:1639846462
Name:PARHAM, ABIGAIL ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELIZABETH
Last Name:PARHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:ELIZABETH
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5801 SW CROZIER CIR APT 208
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-2313
Mailing Address - Country:US
Mailing Address - Phone:870-949-5023
Mailing Address - Fax:
Practice Address - Street 1:3625 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-0351
Practice Address - Country:US
Practice Address - Phone:470-246-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4699225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant