Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PTL-0012747 | CO |
N | 2251X0800X | Physical Therapist - Orthopedic | 040-0095967 | VT |
NPI | 1053745869 |
---|---|
Provider Name | Abigail Allison Good |
First Address | Littleton, CO 80163-0001 |
Second Address | Highlands Ranch, CO 80130-6928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2013 |
Last Update Date | 09/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | CO |