Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 20522 | MD |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT870190 | DC |
NPI | 1134389398 |
---|---|
Provider Name | Jennifer Lynn Issadore |
First Address | Washington, DC 20010-2916 |
Second Address | Washington, DC 20010-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 06/11/2008 |