Healthcare Provider Details

I. General information

NPI: 1225975626
Provider Name (Legal Business Name): RAY SISON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8382 NEWMAN AVE
HUNTINGTON BEACH CA
92647-7038
US

IV. Provider business mailing address

3400 AVENUE OF THE ARTS APT F116
COSTA MESA CA
92626-7173
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number49759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: