Provider Demographics
NPI:1861272841
Name:ZEVGOLIS, ABIGAIL (PTA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:ZEVGOLIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:HARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 GORDON PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1018
Mailing Address - Country:US
Mailing Address - Phone:315-657-1581
Mailing Address - Fax:
Practice Address - Street 1:159 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-342-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001270225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant