Provider Demographics
NPI:1831477512
Name:MCAFEE, ABBY (DPT)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:MCAFEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:DEIBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1719 CLAWSON STREET
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002
Mailing Address - Country:US
Mailing Address - Phone:618-462-1133
Mailing Address - Fax:618-462-3736
Practice Address - Street 1:1719 CLAWSON STREET
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-462-1133
Practice Address - Fax:618-462-3736
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011034565225100000X
IL070018628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01445543OtherRR MEDICARE
ILF400193636Medicare PIN