Provider Demographics
NPI:1215693775
Name:ISENHOUR-BURLAKE, JOHN MAXWELL
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MAXWELL
Last Name:ISENHOUR-BURLAKE
Suffix:
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 1:3400 RODEO AVE
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-7045
Mailing Address - Country:US
Mailing Address - Phone:775-513-4433
Mailing Address - Fax:
Practice Address - Street 1:1601 E BASIN AVE STE 303
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-4612
Practice Address - Country:US
Practice Address - Phone:775-537-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner