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General NPI Number Information
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NPI Number | 1043813744
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Entity Type | Individual
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Provider Name | JENNIFER LYNN SISSON PT
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Gender | Female
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 17 E SIR FRANCIS DRAKE BLVD
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City | LARKSPUR
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State | CA
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Zip | 94939-1727
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Country | US
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Telephone | 415-927-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 549 COMMONWEALTH LN
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City | SARASOTA
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State | FL
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Zip | 34242-1245
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Country | US
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Telephone | 603-657-5801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PT23576
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 29446
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License Number State | CA
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