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Individual
ISRAEL ROBERT LONG
Active
Individual
ISRAEL ROBERT LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT28084
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PT280840
BLUE SHIELD
CA
05
—
PT0280840
—
CA
Enumeration date
01/02/2007
Last updated
07/08/2007
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