Provider Demographics
NPI:1104022599
Name:ISHAK, EMAD R (RPT)
Entity Type:Individual
Prefix:MR
First Name:EMAD
Middle Name:R
Last Name:ISHAK
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10288 HUNT CLUB LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4577
Mailing Address - Country:US
Mailing Address - Phone:561-630-3729
Mailing Address - Fax:
Practice Address - Street 1:7491 RIDGEFIELD LN
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7329
Practice Address - Country:US
Practice Address - Phone:561-436-9595
Practice Address - Fax:561-439-7595
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0008047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6675AMedicare ID - Type UnspecifiedMEDICARE