Provider Demographics
NPI:1134475379
Name:MCISAAC, ANDREW J (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MCISAAC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BOSTON POST RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2434
Mailing Address - Country:US
Mailing Address - Phone:860-444-8713
Mailing Address - Fax:860-444-1671
Practice Address - Street 1:50 BERLIN RD STE 1
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2632
Practice Address - Country:US
Practice Address - Phone:203-284-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist