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General NPI Number Information
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NPI Number | 1487409470
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Entity Type | Organization
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Legal Business Name | ISAAC PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 2085 A1A S STE 105
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City | ST AUGUSTINE BEACH
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State | FL
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Zip | 32080-6505
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Country | US
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Telephone | 904-689-3336
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Fax | 904-779-3213
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Provider Business Mailing Address
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Address Line | 2085 A1A S STE 105
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City | ST AUGUSTINE BEACH
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State | FL
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Zip | 32080-6505
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Country | US
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Telephone | 904-689-3336
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Fax | 904-779-3213
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Authorized Official
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Title or Position | OWNER
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Name | MARISA BALL ISAAC
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Credential | DPT
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Telephone | 904-689-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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