Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 97-07-11-003 | CA |
Y | 226300000X | Kinesiotherapist | 97-07-11-003 | CA |
NPI | 1063657419 |
---|---|
Provider Name | Mr. Kevin Isaacs |
First Address | Los Angeles, CA 90024 |
Second Address | Northridge, CA 91324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2008 |
Last Update Date | 12/12/2008 |