Healthcare Provider Details

I. General information

NPI: 1033423280
Provider Name (Legal Business Name): COLIN SISCO DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 01/20/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 25TH AVE NE STE 201
SEATTLE WA
98105-4152
US

IV. Provider business mailing address

5808 123RD PL SE
SNOHOMISH WA
98296-8900
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-6702
  • Fax: 206-524-6703
Mailing address:
  • Phone: 253-347-3845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36880
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60194624
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: