Provider Demographics
NPI:1548152796
Name:ABUNDANT LIFE PT, LLC
Entity type:Organization
Organization Name:ABUNDANT LIFE PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-884-5508
Mailing Address - Street 1:274 OLD CORVALLIS RD STE Y
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3213
Mailing Address - Country:US
Mailing Address - Phone:406-916-2588
Mailing Address - Fax:
Practice Address - Street 1:274 OLD CORVALLIS RD STE Y
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3213
Practice Address - Country:US
Practice Address - Phone:406-916-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy