Healthcare Provider Details

I. General information

NPI: 1053168179
Provider Name (Legal Business Name): ISAAC A HOUTKOOPER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16320 ROSCOE BLVD
VAN NUYS CA
91406-1250
US

IV. Provider business mailing address

5181 WALNUT RDG
BATTLE CREEK MI
49017-9210
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 269-215-9717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034427
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309429
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.61681248
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2024-0326
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: