Provider Demographics
NPI:1437469012
Name:SISSON, MEGAN (LPTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SISSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 DABNEY ROAD
Mailing Address - Street 2:SUITE D.
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230
Mailing Address - Country:US
Mailing Address - Phone:804-523-2653
Mailing Address - Fax:804-767-4415
Practice Address - Street 1:2034 DABNEY ROAD
Practice Address - Street 2:SUITE D.
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-523-2653
Practice Address - Fax:804-767-4415
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601196225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant