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General NPI Number Information
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NPI Number | 1669666558
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Entity Type | Organization
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Legal Business Name | MA. TERESA SISON ENCISO PT. PC. CORP
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 124 ICHORD AVE
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City | WAYNESVILLE
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State | MO
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Zip | 65583-5406
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Country | US
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Telephone | 573-774-3684
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Fax |
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Provider Business Mailing Address
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Address Line | 1207 STRATFORD LN
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City | ROLLA
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State | MO
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Zip | 65401-3838
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Country | US
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Telephone | 573-774-3684
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Fax |
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Authorized Official
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Title or Position | PT DIRECTOR/PRESIDENT
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Name | MRS. MA. TERESA SISON ENCISO
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Credential | PT
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Telephone | 573-774-3684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | RO911
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License Number State | MO
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