Provider Demographics
NPI:1528274370
Name:NERI, ISAAC QUIOCO (PT)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:QUIOCO
Last Name:NERI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 OLD CAPE RD
Mailing Address - Street 2:APARTMENT C
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2334
Mailing Address - Country:US
Mailing Address - Phone:573-382-6364
Mailing Address - Fax:
Practice Address - Street 1:1514 OLD CAPE RD
Practice Address - Street 2:APARTMENT C
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2334
Practice Address - Country:US
Practice Address - Phone:573-382-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005037322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist