Provider Demographics
NPI:1417069527
Name:SISON, NOEL S (PT)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:S
Last Name:SISON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 DONNELLY DR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6422
Mailing Address - Country:US
Mailing Address - Phone:561-641-3612
Mailing Address - Fax:561-641-3909
Practice Address - Street 1:3400 JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2080
Practice Address - Country:US
Practice Address - Phone:561-317-1374
Practice Address - Fax:561-641-3909
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY905JOtherBLUE CROSS BLUE SHIELD
FLY905JOtherBLUE CROSS BLUE SHIELD