Healthcare Provider Details

I. General information

NPI: 1154919538
Provider Name (Legal Business Name): ALYSSA Y ISAAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12116 ALEXANDER RD UNIT A
EVERETT WA
98204-4720
US

IV. Provider business mailing address

12116 ALEXANDER RD UNIT A
EVERETT WA
98204-4720
US

V. Phone/Fax

Practice location:
  • Phone: 516-474-6612
  • Fax:
Mailing address:
  • Phone: 516-474-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number61089383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: