Provider Demographics
NPI:1184375438
Name:PODELL, ISAAC LEWIS (PT, DPT)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:LEWIS
Last Name:PODELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8574
Mailing Address - Country:US
Mailing Address - Phone:540-986-5024
Mailing Address - Fax:
Practice Address - Street 1:1421 3RD ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5204
Practice Address - Country:US
Practice Address - Phone:540-982-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist