Healthcare Provider Details

I. General information

NPI: 1295422178
Provider Name (Legal Business Name): RHEA ANN ISAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

89 STEELE WAY
HUNTINGDON VALLEY PA
19006-3115
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4701
  • Fax:
Mailing address:
  • Phone: 215-740-9282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA064450
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: