Individual
JENNIFER SUE ISHIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3875
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054984003
BLUE CROSS
—
01
—
650024379
RR MEDICARE
—
Enumeration date
08/18/2006
Last updated
02/28/2009
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