Provider Demographics
NPI:1245768514
Name:SISSON&ASSOCIATES LLC
Entity Type:Organization
Organization Name:SISSON&ASSOCIATES LLC
Other - Org Name:PHYSICAL THERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ARNAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:804-269-7158
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:MONTROSS
Mailing Address - State:VA
Mailing Address - Zip Code:22520-0579
Mailing Address - Country:US
Mailing Address - Phone:804-269-1588
Mailing Address - Fax:
Practice Address - Street 1:17248 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MONTROSS
Practice Address - State:VA
Practice Address - Zip Code:22520-2724
Practice Address - Country:US
Practice Address - Phone:804-269-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty