Provider Demographics
NPI:1942746243
Name:ELLIOTT, ABBY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 SOUTHWEST PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6220
Mailing Address - Country:US
Mailing Address - Phone:512-299-9734
Mailing Address - Fax:
Practice Address - Street 1:5901 SOUTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6220
Practice Address - Country:US
Practice Address - Phone:512-299-9734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0900020382255A2300X
TXAT46582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer