Provider Demographics
NPI:1912278649
Name:KLOCH, ISAAC (DPT)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:KLOCH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 DORCHESTER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2425
Mailing Address - Country:US
Mailing Address - Phone:410-228-5100
Mailing Address - Fax:410-228-7479
Practice Address - Street 1:321 DORCHESTER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2425
Practice Address - Country:US
Practice Address - Phone:410-228-5100
Practice Address - Fax:410-228-7479
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist