Provider Demographics
NPI:1518404243
Name:SISU SPORTS PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:SISU SPORTS PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:309-826-7430
Mailing Address - Street 1:11736 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4916
Mailing Address - Country:US
Mailing Address - Phone:309-826-7430
Mailing Address - Fax:
Practice Address - Street 1:11736 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4916
Practice Address - Country:US
Practice Address - Phone:309-826-7430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60131890261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy