Provider Demographics
NPI:1861453474
Name:STODDARD, ABBI M (PT)
Entity Type:Individual
Prefix:
First Name:ABBI
Middle Name:M
Last Name:STODDARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ABBI
Other - Middle Name:M
Other - Last Name:STODDARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:207 S BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5905
Mailing Address - Country:US
Mailing Address - Phone:402-462-8824
Mailing Address - Fax:
Practice Address - Street 1:207 S BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5905
Practice Address - Country:US
Practice Address - Phone:402-462-8824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist