Provider Demographics
NPI:1497915821
Name:SISTO, SUE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUE ANN
Middle Name:
Last Name:SISTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MILLBURN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1847
Mailing Address - Country:US
Mailing Address - Phone:976-467-7976
Mailing Address - Fax:973-467-7971
Practice Address - Street 1:187 MILLBURN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1847
Practice Address - Country:US
Practice Address - Phone:976-467-7976
Practice Address - Fax:973-467-7971
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00210600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist