Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | PT0000004903 | TN |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT4292 | MS |
NPI | 1043493877 |
---|---|
Provider Name | Karen Kay Sisco |
First Address | Arlington, TN 38002-9512 |
Second Address | Arlington, TN 38002-9512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2007 |
Last Update Date | 01/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08602897 | (05) | MS |