1316929532 NPI number — JOSEPH A ISAAC PT, CSCS

Table of content: JOSEPH A ISAAC PT, CSCS (NPI 1316929532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316929532 NPI number — JOSEPH A ISAAC PT, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAAC
Provider First Name:
JOSEPH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ISAAC
Provider Other First Name:
JOSEPH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316929532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 GREENUP AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41101-1953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-324-0540
Provider Business Mailing Address Fax Number:
606-324-0616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 SOUTH THIRD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRONTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45638-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-534-1156
Provider Business Practice Location Address Fax Number:
740-534-1158
Provider Enumeration Date:
11/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2055181 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8700024600 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005044000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005044001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005044001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87000246 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 650014888 . This is a "MEDICARE RR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2055182 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005044001 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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