Provider Demographics
NPI:1679240766
Name:MIHULKA, ABIGAIL JAYNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JAYNE
Last Name:MIHULKA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:JAYNE
Other - Last Name:VERSEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:611 E STAR CT STE B
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6704
Mailing Address - Country:US
Mailing Address - Phone:970-249-1646
Mailing Address - Fax:
Practice Address - Street 1:611 E STAR CT STE B
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6704
Practice Address - Country:US
Practice Address - Phone:702-249-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00178912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic