Healthcare Provider Details

I. General information

NPI: 1851725352
Provider Name (Legal Business Name): KATHERINE SISSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 ROUTE 15
JEFFERSONVILLE VT
05464
US

IV. Provider business mailing address

P.O. BOX 103
JEFFERSONVILLE VT
05464
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-8011
  • Fax: 802-893-7429
Mailing address:
  • Phone: 802-644-8011
  • Fax: 802-644-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0095390
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: