Provider Demographics
NPI:1902029101
Name:SISON, PAUL MONTESA (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MONTESA
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:PO BOX 11670
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-1670
Mailing Address - Country:US
Mailing Address - Phone:281-370-0868
Mailing Address - Fax:
Practice Address - Street 1:16328 STUEBNER AIRLINE RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7332
Practice Address - Country:US
Practice Address - Phone:281-370-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00953XMedicare ID - Type Unspecified