Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 4031 | AR |
NPI | 1013375575 |
---|---|
Provider Name | Kimberlie Sisson |
First Address | White Hall, AR 71602-2616 |
Second Address | White Hall, AR 71602-2616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2016 |
Last Update Date | 29/01/2016 |