Provider Demographics
NPI:1831186485
Name:ISAACSON, KALE R (PT)
Entity type:Individual
Prefix:MR
First Name:KALE
Middle Name:R
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1334 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5067
Mailing Address - Country:US
Mailing Address - Phone:505-292-3317
Mailing Address - Fax:505-292-3402
Practice Address - Street 1:1334 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5067
Practice Address - Country:US
Practice Address - Phone:505-292-3317
Practice Address - Fax:505-292-3402
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9372251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00Q451OtherBCBS
NM66908001Medicaid
349341121Medicare PIN