Healthcare Provider Details

I. General information

NPI: 1487409470
Provider Name (Legal Business Name): ISAAC PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 A1A S STE 105
ST AUGUSTINE BEACH FL
32080-6505
US

IV. Provider business mailing address

2085 A1A S STE 105
ST AUGUSTINE BEACH FL
32080-6505
US

V. Phone/Fax

Practice location:
  • Phone: 904-689-3336
  • Fax: 904-779-3213
Mailing address:
  • Phone: 904-689-3336
  • Fax: 904-779-3213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARISA BALL ISAAC
Title or Position: OWNER
Credential: DPT
Phone: 904-689-3336