Healthcare Provider Details

I. General information

NPI: 1649355603
Provider Name (Legal Business Name): ANGELA D ISAAC PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MOULTRIE ST
SAN FRANCISCO CA
94110-6034
US

IV. Provider business mailing address

630 MOULTRIE ST
SAN FRANCISCO CA
94110-6034
US

V. Phone/Fax

Practice location:
  • Phone: 415-648-0196
  • Fax: 415-374-7058
Mailing address:
  • Phone: 415-648-0196
  • Fax: 415-374-7058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: