Provider Demographics
NPI:1144896143
Name:VICK, ABIGAIL LEONARD (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:LEONARD
Last Name:VICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:626 BRIDGEPORT CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-9150
Practice Address - Country:US
Practice Address - Phone:919-981-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist