Provider Demographics
NPI:1679961304
Name:ABEGGLEN, CORRIE ELIZABETH (MSPT)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:ELIZABETH
Last Name:ABEGGLEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CORRIE
Other - Middle Name:ELIZABETH
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1818 FAIRHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-2645
Mailing Address - Country:US
Mailing Address - Phone:678-357-0309
Mailing Address - Fax:
Practice Address - Street 1:345 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2654
Practice Address - Country:US
Practice Address - Phone:678-357-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021102225100000X
GAPT007671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist