Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 33553 | FL |
NPI | 1063992030 |
---|---|
Provider Name | Ms. Kayla Sisson |
First Address | Jacksonville, FL 32277-2507 |
Second Address | Jacksonville, FL 32216-8042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2018 |
Last Update Date | 18/08/2018 |