Provider Demographics
NPI:1881879104
Name:SMITH, ABIGAIL J (DPT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:J
Last Name:SMITH
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 1:772 POST RD E STE 2
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5229
Mailing Address - Country:US
Mailing Address - Phone:203-215-4142
Mailing Address - Fax:
Practice Address - Street 1:772 POST RD E STE 2
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5229
Practice Address - Country:US
Practice Address - Phone:203-215-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-05
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008422225100000X, 2251X0800X
PA019455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008422OtherLICENSE