Provider Demographics
NPI:1013627413
Name:ISEN, AMANDA (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:ISEN
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 1:1320 N VEITCH ST UNIT 1427
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-6217
Mailing Address - Country:US
Mailing Address - Phone:608-628-4571
Mailing Address - Fax:
Practice Address - Street 1:1010 WAYNE AVE STE 410
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5655
Practice Address - Country:US
Practice Address - Phone:240-600-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist