=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245768514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SISSON&ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2017
-----------------------------------------------------
Last Update Date | 05/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17248 KINGS HWY
-----------------------------------------------------
City | MONTROSS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22520-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-269-1588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 579
-----------------------------------------------------
City | MONTROSS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22520-0579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-269-1588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL/SOLE MEMBER
-----------------------------------------------------
Name | ARNAN LEE SISSON
-----------------------------------------------------
Credential | MSPT
-----------------------------------------------------
Telephone | 804-269-7158
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305210513
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------