Provider Demographics
NPI:1063382216
Name:ISA, SPENCER K (DPT)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:K
Last Name:ISA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:550 SAINT CHARLES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3969
Mailing Address - Country:US
Mailing Address - Phone:805-777-1023
Mailing Address - Fax:888-506-7977
Practice Address - Street 1:550 SAINT CHARLES DR STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3969
Practice Address - Country:US
Practice Address - Phone:805-777-1023
Practice Address - Fax:888-506-7977
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT309156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist