Provider Demographics
NPI:1841650660
Name:ISANG, UDIM (PT, DPT, EDD)
Entity type:Individual
Prefix:DR
First Name:UDIM
Middle Name:
Last Name:ISANG
Suffix:
Gender:X
Credentials:PT, DPT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 UPSHUR ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3240
Mailing Address - Country:US
Mailing Address - Phone:240-421-4777
Mailing Address - Fax:
Practice Address - Street 1:1808 UPSHUR ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3240
Practice Address - Country:US
Practice Address - Phone:240-421-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871922225100000X
MD25901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist