Provider Demographics
NPI:1275025223
Name:ISOM, ALEX TERRILL (DPT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:TERRILL
Last Name:ISOM
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 1:2670 MCINGVALE RD STE J
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8696
Mailing Address - Country:US
Mailing Address - Phone:901-641-3000
Mailing Address - Fax:901-701-2428
Practice Address - Street 1:2670 MCINGVALE RD STE J
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-8696
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-701-2428
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCP002847T225100000X
MSPT6453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist