Provider Demographics
NPI:1104529585
Name:ISOM, TERRY L JR
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:ISOM
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 REVEREND NATHANIEL L HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7226
Mailing Address - Country:US
Mailing Address - Phone:321-505-8010
Mailing Address - Fax:
Practice Address - Street 1:2160 APPIAN WAY STE 101
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2524
Practice Address - Country:US
Practice Address - Phone:510-724-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant