Provider Demographics
NPI:1063657419
Name:ISAACS, KEVIN (MS, CPT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:ISAACS
Suffix:
Gender:M
Credentials:MS, CPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10933 ROCHESTER AVE
Mailing Address - Street 2:SUITE #216
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-801-4129
Mailing Address - Fax:310-966-1175
Practice Address - Street 1:9150 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:310-801-4129
Practice Address - Fax:310-966-1175
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97-07-11-003225XN1300X, 226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation