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NPI Code Detail

MEDICARE: DENNIS KIRK SISSOM LPTA

MEDICARE: DENNIS KIRK SISSOM LPTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant117159MO

General Provider Information

NPI Number : 1528669827
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENNIS KIRK SISSOM LPTA
Provider Business Mailing Address
First Line : 26 BROZ RD
Second Line :
City : BELLFLOWER
State : MO
Zip : 63333-2700
Country : US
Telephone Number : 314-420-8954
Fax Number : 636-720-3388
Provider Business Practice Location Address
First Line : 600 BREEZE PARK DR
Second Line :
City : WELDON SPRING
State : MO
Zip : 63304-9139
Country : US
Telephone Number : 636-229-5996
Fax Number : 636-720-3388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2020
Last Update Date : 11/03/2020

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Directions to “ DENNIS KIRK SISSOM LPTA” Practice Location

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