Provider Demographics
NPI:1003277583
Name:HEREAU, ABIGAIL ANNE (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ANNE
Last Name:HEREAU
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:ANNE
Other - Last Name:FLAMINIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:1345 WINDING RIDGE DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7573
Mailing Address - Country:US
Mailing Address - Phone:906-399-4181
Mailing Address - Fax:
Practice Address - Street 1:10483 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-9311
Practice Address - Country:US
Practice Address - Phone:810-498-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020150225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist