Provider Demographics
NPI:1851725352
Name:SISSON, KATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SISSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 103
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05464
Mailing Address - Country:US
Mailing Address - Phone:802-644-8011
Mailing Address - Fax:802-644-8047
Practice Address - Street 1:5016 ROUTE 15
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05464
Practice Address - Country:US
Practice Address - Phone:802-644-8011
Practice Address - Fax:802-893-7429
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0095390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022195Medicaid