Provider Demographics
NPI:1295417095
Name:LISTER, ABBY TAYLOR
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:TAYLOR
Last Name:LISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MCCAIN LN APT 10
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4601
Mailing Address - Country:US
Mailing Address - Phone:785-747-7947
Mailing Address - Fax:
Practice Address - Street 1:2011 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1159
Practice Address - Country:US
Practice Address - Phone:785-458-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant