Provider Demographics
NPI:1275765422
Name:SISCO, ERIN COLLEEN (PT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:COLLEEN
Last Name:SISCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:COLLEEN
Other - Last Name:FORCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:67505 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1925
Mailing Address - Country:US
Mailing Address - Phone:586-727-0018
Mailing Address - Fax:586-727-0028
Practice Address - Street 1:67505 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1925
Practice Address - Country:US
Practice Address - Phone:586-727-0018
Practice Address - Fax:586-727-0028
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist