Provider Demographics
NPI:1720285778
Name:CLINARD, ABBY DAWN
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:DAWN
Last Name:CLINARD
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 1:5541 BENT FORK
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WESTPARK REHABILITATION CENTER
Practice Address - Street 2:25 S BOEHNE CAMP ROAD
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712
Practice Address - Country:US
Practice Address - Phone:812-423-7468
Practice Address - Fax:812-423-7568
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003289A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155238Medicaid