Provider Demographics
NPI:1689868879
Name:ISENBERG, ERIC D (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:D
Last Name:ISENBERG
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 1:1181 AQUIDNECK AVE
Mailing Address - Street 2:OLYMPIC PHYSICIAL THERAPY
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-845-0840
Mailing Address - Fax:401-845-0842
Practice Address - Street 1:1181 AQUIDNECK AVE
Practice Address - Street 2:OLYMPIC PHYSICIAL THERAPY
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-845-0840
Practice Address - Fax:401-845-0842
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPT02109OtherMEDICARE ID-TYPE UNSPECIFIED
RIPT02109OtherMEDICARE ID-TYPE UNSPECIFIED