Provider Demographics
NPI:1811087331
Name:ISAACKS, TRACY RENEE (PT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:RENEE
Last Name:ISAACKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 AUTUMN CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3150
Mailing Address - Country:US
Mailing Address - Phone:281-332-0848
Mailing Address - Fax:
Practice Address - Street 1:5313 DECKER DRIVE
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520
Practice Address - Country:US
Practice Address - Phone:281-838-4477
Practice Address - Fax:281-838-4480
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83124TOtherBCBS