Provider Demographics
NPI:1134427701
Name:DUTRA, ISABEL (DPT)
Entity type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:
Last Name:DUTRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6446 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-9003
Mailing Address - Country:US
Mailing Address - Phone:559-381-0245
Mailing Address - Fax:
Practice Address - Street 1:4107 HOHE ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7008
Practice Address - Country:US
Practice Address - Phone:559-381-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37452225100000X
HI4752225100000X
AK160274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist