Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | 028222-1 | NY |
Y | 2251N0400X | Physical Therapist - Neurology | 2643 | AZ |
NPI | 1760618177 |
---|---|
Provider Name | Tara L Mcisaac |
First Address | Tempe, AZ 85281-6521 |
Second Address | Tempe, AZ 85281-6521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2009 |
Last Update Date | 10/08/2013 |