Provider Demographics
NPI:1336782523
Name:FAGERHOLM, ABIGAIL (DPT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:FAGERHOLM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9793
Mailing Address - Country:US
Mailing Address - Phone:860-413-2073
Mailing Address - Fax:
Practice Address - Street 1:138 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9793
Practice Address - Country:US
Practice Address - Phone:860-413-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist