Provider Demographics
NPI:1396073623
Name:BISACCIA, ANDREW J (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:BISACCIA
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 1:7070 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-5902
Mailing Address - Country:US
Mailing Address - Phone:805-685-1755
Mailing Address - Fax:805-685-1715
Practice Address - Street 1:7070 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-5902
Practice Address - Country:US
Practice Address - Phone:805-685-1755
Practice Address - Fax:805-685-1715
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist