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NPI Code Detail

MEDICARE: ISAAC CISNEROS PT, DPT

MEDICARE: ISAAC CISNEROS PT, 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
1225100000XPhysical Therapist64479OR

General Provider Information

NPI Number : 1396515672
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISAAC CISNEROS PT, DPT
Provider Business Mailing Address
First Line : 305 FLOWER LN
Second Line :
City : DAYTON
State : OR
Zip : 97114-9740
Country : US
Telephone Number : 503-435-8674
Fax Number :
Provider Business Practice Location Address
First Line : 3060 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-3053
Country : US
Telephone Number : 503-535-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2024
Last Update Date : 01/25/2026

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