Provider Demographics
NPI:1174111454
Name:KISOR, ABBY
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:KISOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45884 227TH ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:SD
Mailing Address - Zip Code:57057-6400
Mailing Address - Country:US
Mailing Address - Phone:605-270-9397
Mailing Address - Fax:
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:SD
Practice Address - Zip Code:57212-2084
Practice Address - Country:US
Practice Address - Phone:605-556-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
SD6072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program