Provider Demographics
NPI:1669972766
Name:HORSCH, ISAAC GRANT (ATC)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:GRANT
Last Name:HORSCH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 COUNTY ROAD 300 E
Mailing Address - Street 2:
Mailing Address - City:FISHER
Mailing Address - State:IL
Mailing Address - Zip Code:61843-9761
Mailing Address - Country:US
Mailing Address - Phone:217-778-8201
Mailing Address - Fax:
Practice Address - Street 1:6700 WALL ST APT 10H
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4530
Practice Address - Country:US
Practice Address - Phone:217-778-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27712255A2300X
390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
940571303-02OtherHEALTH ALLIANCE