Basic Information
| Provider Information | |||||||||
| NPI: | 1942700067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KESSLER | ||||||||
| FirstName: | ABBIE | ||||||||
| MiddleName: | N | ||||||||
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| OtherLastName: | CRONE | ||||||||
| OtherFirstName: | ABBIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7 DOCK HILL RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178428910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708372123 | ||||||||
| FaxNumber: | 5708372185 | ||||||||
| Practice Location | |||||||||
| Address1: | 5040 SPRING RD | ||||||||
| Address2: | |||||||||
| City: | SHERMANS DALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170908316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175827172 | ||||||||
| FaxNumber: | 7175820068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2018 | ||||||||
| LastUpdateDate: | 02/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT026720 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1034623330016 | 05 | PA | MEDICAID |