Provider Demographics
NPI:1972912855
Name:VAN AMERONGEN, ABIGAIL L (PT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:L
Last Name:VAN AMERONGEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:L
Other - Last Name:FELKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:200 NE MOTHER JOSEPH PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3299
Mailing Address - Country:US
Mailing Address - Phone:360-254-6161
Mailing Address - Fax:360-449-1139
Practice Address - Street 1:2121 NE 139TH ST
Practice Address - Street 2:SUITE 325
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2316
Practice Address - Country:US
Practice Address - Phone:360-254-6161
Practice Address - Fax:360-449-1139
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist