Provider Demographics
NPI:1235142290
Name:NIEVES, ABBY LEIGH (MSPT)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LEIGH
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 DALLAS PKWY STE 290
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7493
Mailing Address - Country:US
Mailing Address - Phone:945-050-0010
Mailing Address - Fax:
Practice Address - Street 1:9638 S ROBERTS RD
Practice Address - Street 2:UNIT B36
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2238
Practice Address - Country:US
Practice Address - Phone:708-237-4270
Practice Address - Fax:708-237-4272
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist