Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 29446 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT23576 | FL |
NPI | 1043813744 |
---|---|
Provider Name | Mrs. Jennifer Lynn Sisson |
First Address | Sarasota, FL 34242-1245 |
Second Address | Larkspur, CA 94939-1727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2020 |
Last Update Date | 17/11/2020 |