Provider Demographics
NPI:1477379840
Name:PINEDA, ABIGAIL JANETTE
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JANETTE
Last Name:PINEDA
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 1:205 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3739
Mailing Address - Country:US
Mailing Address - Phone:254-715-2265
Mailing Address - Fax:
Practice Address - Street 1:715 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9056
Practice Address - Country:US
Practice Address - Phone:316-283-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist