Healthcare Provider Details

I. General information

NPI: 1356762470
Provider Name (Legal Business Name): STEVEN CISCO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 FRANKLIN TPKE
ALLENDALE NJ
07401-2211
US

IV. Provider business mailing address

221 FRANKLIN TPKE
ALLENDALE NJ
07401-2211
US

V. Phone/Fax

Practice location:
  • Phone: 206-383-8687
  • Fax:
Mailing address:
  • Phone: 206-383-8687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02184700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: