Provider Demographics
NPI:1982189916
Name:BRETZIN, ABIGAIL C (PHD, ATC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:C
Last Name:BRETZIN
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 GUARDIAN DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4865
Mailing Address - Country:US
Mailing Address - Phone:716-801-0015
Mailing Address - Fax:
Practice Address - Street 1:423 GUARDIAN DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4865
Practice Address - Country:US
Practice Address - Phone:716-801-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0056312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer