Provider Demographics
NPI:1386184075
Name:MARKOSE, JISHA (DPT)
Entity Type:Individual
Prefix:
First Name:JISHA
Middle Name:
Last Name:MARKOSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 NORTHLAKE PARKWAY
Mailing Address - Street 2:APARTMENT101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827
Mailing Address - Country:US
Mailing Address - Phone:407-470-4546
Mailing Address - Fax:
Practice Address - Street 1:9210 NORTHLAKE PKWY
Practice Address - Street 2:APARTMENT101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5716
Practice Address - Country:US
Practice Address - Phone:407-470-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist