Provider Demographics
NPI:1841238284
Name:ABI MEDICAL GROUP
Entity Type:Organization
Organization Name:ABI MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-920-7772
Mailing Address - Street 1:315 E DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1807
Mailing Address - Country:US
Mailing Address - Phone:970-920-7772
Mailing Address - Fax:970-544-2509
Practice Address - Street 1:315 E DEAN ST
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1807
Practice Address - Country:US
Practice Address - Phone:970-920-7772
Practice Address - Fax:970-544-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9165OtherPHYSICAL THERAPY LICENSE
TX89H353Medicare ID - Type UnspecifiedM.D.