MEDICARE: SAMANTHA MCISAAC DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTP-PT-LIC-17174	MT

General Provider Information

NPI Number	:	1083377105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MCISAAC DPT

Provider Business Mailing Address
First Line	:	3251 104T AVE SW
Second Line	:
City	:	DICKINSON
State	:	ND
Zip	:	58601-9032
Country	:	US
Telephone Number	:	701-690-1216
Fax Number	:

Provider Business Practice Location Address
First Line	:	1595 GRAND AVE STE 265
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-3072
Country	:	US
Telephone Number	:	406-371-5209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	11/15/2022

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