Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 05010562A | IN |
Y | 2251C2600X | Cardiopulmonary | 05010562A | IN |
NPI | 1154877512 |
---|---|
Provider Name | Mrs. Abigail Jane Freese |
First Address | Brownsburg, IN 46112-7455 |
Second Address | Raleigh, NC 27616-2815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2016 |
Last Update Date | 10/02/2020 |