Provider Demographics
NPI:1780678987
Name:ABELLA, AGNES R (PT)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:R
Last Name:ABELLA
Suffix:
Gender:F
Credentials:PT
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 71121
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-1121
Mailing Address - Country:US
Mailing Address - Phone:865-992-6933
Mailing Address - Fax:865-992-6870
Practice Address - Street 1:110 SKYLINE DR STE B
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3063
Practice Address - Country:US
Practice Address - Phone:865-992-6933
Practice Address - Fax:865-992-6870
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist