Healthcare Provider Details

I. General information

NPI: 1134389398
Provider Name (Legal Business Name): JENNIFER LYNN ISSADORE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW STE 1300 DEPT. OF PHYSICAL THERAPY
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW STE 1300 DEPT. OF PHYSICAL THERAPY
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-3019
  • Fax: 202-476-5979
Mailing address:
  • Phone: 202-476-3019
  • Fax: 202-476-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT870190
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20522
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: