Provider Demographics
NPI:1932499613
Name:CLEARY, ABIGAIL CORNISH (PT, DPT, MTC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CORNISH
Last Name:CLEARY
Suffix:
Gender:F
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:LOUISE
Other - Last Name:CORNISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:540 W CROSSVILLE RD STE 203
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7524
Practice Address - Country:US
Practice Address - Phone:678-585-0175
Practice Address - Fax:678-585-7483
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207523225100000X
TX1193795225100000X
GAPT013277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist