Kristopher D Isenberg

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2088680 Issued in TX

Practice address

307 Geralo Lane
Lynn Haven, FL 32444

Phone

(850) 819-4981

NPI assigned

Jul 27, 2012

Last updated

Aug 28, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535414400000",
    "number": "1871849836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 MADDIE AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762447583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 GERALO LANE",
            "city": "LYNN HAVEN",
            "state": "FL",
            "postal_code": "32444",
            "telephone_number": "850-819-4981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISENBERG",
        "first_name": "KRISTOPHER",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-27",
        "last_updated": "2018-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA21973",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2088680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871849836",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Lynn Haven, FL
• Providers in Lynn Haven, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.