Provider Demographics
NPI:1972887693
Name:FIETZER, ABBIGAIL LYNN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ABBIGAIL
Middle Name:LYNN
Last Name:FIETZER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 CENTURY PARK E
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CENTURY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90067-1705
Mailing Address - Country:US
Mailing Address - Phone:310-286-0447
Mailing Address - Fax:310-286-1224
Practice Address - Street 1:1950 CENTURY PARK E
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CENTURY CITY
Practice Address - State:CA
Practice Address - Zip Code:90067-1705
Practice Address - Country:US
Practice Address - Phone:310-286-0447
Practice Address - Fax:310-286-1224
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist