Provider Demographics
NPI:1730805847
Name:DEMIJAN, ABIGAIL HELSTROM (DPT)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:HELSTROM
Last Name:DEMIJAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-3215
Mailing Address - Country:US
Mailing Address - Phone:847-754-8201
Mailing Address - Fax:
Practice Address - Street 1:23830 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:CO
Practice Address - Zip Code:80645-8612
Practice Address - Country:US
Practice Address - Phone:970-451-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00187312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL.0018731OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES