Provider Demographics
NPI:1649851122
Name:CLEARY, ABIGAIL F (PT, DPT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:F
Last Name:CLEARY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 412307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2307
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:1009 CENTERBROOKE LN STE 103
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8664
Practice Address - Country:US
Practice Address - Phone:757-774-5600
Practice Address - Fax:757-216-1141
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist