Provider Demographics
NPI:1922731652
Name:AB DIRECT THERAPY LLC
Entity Type:Organization
Organization Name:AB DIRECT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADWATER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:814-792-5501
Mailing Address - Street 1:396 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15534-1703
Mailing Address - Country:US
Mailing Address - Phone:814-792-5501
Mailing Address - Fax:
Practice Address - Street 1:396 WALKER RD
Practice Address - Street 2:
Practice Address - City:BUFFALO MILLS
Practice Address - State:PA
Practice Address - Zip Code:15534-1703
Practice Address - Country:US
Practice Address - Phone:814-792-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech