Provider Demographics
NPI:1255064812
Name:HERRON, ABIGAIL (PT, DPT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 COOKS POND DR NE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1152
Mailing Address - Country:US
Mailing Address - Phone:614-915-6667
Mailing Address - Fax:
Practice Address - Street 1:2685 CELANESE RD STE 105
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2994
Practice Address - Country:US
Practice Address - Phone:803-661-5033
Practice Address - Fax:864-643-2327
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty