Provider Demographics
NPI:1609205665
Name:ISANAKA, KALYANI (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KALYANI
Middle Name:
Last Name:ISANAKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:KALYANI
Other - Middle Name:
Other - Last Name:ISANAKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:70 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3925
Mailing Address - Country:US
Mailing Address - Phone:603-893-2900
Mailing Address - Fax:603-898-1372
Practice Address - Street 1:101 AMESBURY ST FL 3
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1323
Practice Address - Country:US
Practice Address - Phone:978-975-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-10
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist