Healthcare Provider Details

I. General information

NPI: 1083501654
Provider Name (Legal Business Name): ISABEL MELO SISON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 W CERMAK RD STE 110
RIVERSIDE IL
60546-1449
US

IV. Provider business mailing address

PO BOX 735263
CHICAGO IL
60673-5263
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2826
  • Fax: 708-409-5179
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070029088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: