MEDICARE: MRS. MELANIE KAY SISSON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT3195	AR

General Provider Information

NPI Number	:	1225361652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE KAY SISSON DPT

Provider Business Mailing Address
First Line	:	PO BOX 297
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012-0297
Country	:	US
Telephone Number	:	501-882-2260
Fax Number	:	501-882-2369

Provider Business Practice Location Address
First Line	:	710 W DEWITT HENRY DR
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012-2102
Country	:	US
Telephone Number	:	501-882-2260
Fax Number	:	501-882-2369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	01/16/2014

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