Provider Demographics
NPI:1689187346
Name:ABBOTT, PHIL (PTA)
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2471
Mailing Address - Country:US
Mailing Address - Phone:484-557-0229
Mailing Address - Fax:
Practice Address - Street 1:3000 BALFOUR CIR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2144
Practice Address - Country:US
Practice Address - Phone:484-920-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant