Provider Demographics
NPI:1952120289
Name:ABRAHAM, ANGELA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:ABRAHAM
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 1:2383 AKERS MILL RD SE APT N16
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2528
Mailing Address - Country:US
Mailing Address - Phone:630-800-9202
Mailing Address - Fax:
Practice Address - Street 1:1995 N PARK PL SE STE 410
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2072
Practice Address - Country:US
Practice Address - Phone:770-850-0390
Practice Address - Fax:770-818-9726
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist