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General NPI Number Information
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NPI Number | 1215693775
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Entity Type | Individual
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Provider Name | JOHN MAXWELL ISENHOUR-BURLAKE
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Gender | Male
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 1601 E BASIN AVE STE 303
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City | PAHRUMP
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State | NV
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Zip | 89060-4612
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Country | US
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Telephone | 775-537-8898
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 RODEO AVE
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City | PAHRUMP
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State | NV
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Zip | 89048-7045
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Country | US
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Telephone | 775-513-4433
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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