Healthcare Provider Details

I. General information

NPI: 1902275720
Provider Name (Legal Business Name): KISHNA SISCA PHYSICAL THERAPY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10290 GENTLEWOOD FOREST DR
BOYNTON BEACH FL
33473-4862
US

IV. Provider business mailing address

10290 GENTLEWOOD FOREST DR
BOYNTON BEACH FL
33473-4862
US

V. Phone/Fax

Practice location:
  • Phone: 561-704-7224
  • Fax: 561-336-3548
Mailing address:
  • Phone: 561-704-7224
  • Fax: 561-336-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number18059
License Number StateFL

VIII. Authorized Official

Name: MRS. KISHNA NICOLE SISCA
Title or Position: PRESIDENT
Credential: PT
Phone: 561-704-7224