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General NPI Number Information
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NPI Number | 1013891811
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Entity Type | Individual
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Provider Name | ALEESIA ISOM
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Gender |
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1801 RUFE SNOW DR STE 200
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City | KELLER
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State | TX
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Zip | 76248-5712
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Country | US
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Telephone | 817-393-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 4330 METRONOME DR
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-4336
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1376344
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License Number State | TX
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