Active NPI
Isaac Deanda
- Physical Therapist
- Fort Worth, TX
National Provider Identifier
1760183131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1336628
- Practice address
- 10404 Morning Dew St
Fort Worth, TX 76108-4922 - Phone
- (325) 267-4111
- NPI assigned
- Mar 13, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1336628 | TX | Primary |
Addresses
Primary practice location
10404 Morning Dew St
Fort Worth, TX 76108-4922
Mailing address
10404 Morning Dew St
Fort Worth, TX 76108-4922
Phone (325) 267-4111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230609000822 | TX | Practitioner - Physical Therapist in Private Practice | 2860859626 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1336628 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682985600000",
"number": "1760183131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10404 MORNING DEW ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761084922",
"telephone_number": "325-267-4111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10404 MORNING DEW ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761084922",
"telephone_number": "325-267-4111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEANDA",
"first_name": "ISAAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-13",
"last_updated": "2023-05-02",
"certification_date": "2023-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1336628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.