Provider Demographics
NPI:1477592251
Name:ISHERWOOD, DAVID V (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:V
Last Name:ISHERWOOD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-9579
Mailing Address - Country:US
Mailing Address - Phone:585-226-2578
Mailing Address - Fax:
Practice Address - Street 1:465 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4645
Practice Address - Country:US
Practice Address - Phone:585-463-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist