Provider Demographics
NPI:1801281878
Name:ISSA, NIEMAT
Entity type:Individual
Prefix:
First Name:NIEMAT
Middle Name:
Last Name:ISSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 EDGEWOOD AVE W STE 6B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-7208
Mailing Address - Country:US
Mailing Address - Phone:904-768-9966
Mailing Address - Fax:904-367-8760
Practice Address - Street 1:1771 EDGEWOOD AVE W STE 6B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-7208
Practice Address - Country:US
Practice Address - Phone:904-768-9966
Practice Address - Fax:904-367-8760
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6568225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation