Provider Demographics
NPI:1487409470
Name:ISAAC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ISAAC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:BALL
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:904-689-3336
Mailing Address - Street 1:2085 A1A S STE 105
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6505
Mailing Address - Country:US
Mailing Address - Phone:904-689-3336
Mailing Address - Fax:904-779-3213
Practice Address - Street 1:2085 A1A S STE 105
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32080-6505
Practice Address - Country:US
Practice Address - Phone:904-689-3336
Practice Address - Fax:904-779-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy