Provider Demographics
NPI:1508606039
Name:WELLS, ABIGAIL HOLLADAY (DPT)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:HOLLADAY
Last Name:WELLS
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:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-1004
Mailing Address - Country:US
Mailing Address - Phone:731-613-2214
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1004
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-1004
Practice Address - Country:US
Practice Address - Phone:731-613-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TN15709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist