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General NPI Number Information
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NPI Number | 1154718468
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Entity Type | Individual
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Provider Name | ISAIAH IAEA
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Gender | Male
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 2035 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-2223
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Country | US
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Telephone | 808-428-4184
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 711185
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City | SALT LAKE CITY
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State | UT
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Zip | 84171-1185
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Country | US
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Telephone | 801-942-3311
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Fax | 801-942-5955
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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 | 3701
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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