Organization
PEDIATRIC THERAPY SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN K. SISCO PT (SOLE PROPRIETOR)
(901) 292-5313
Entity
Organization
Contact information
Practice address
11315 MCCORMICK RD, ARLINGTON, TN 38002-9512
(901) 292-5313
Mailing address
11315 MCCORMICK RD, ARLINGTON, TN 38002-9512
(901) 292-5313
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT4292
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08602897
—
MS
Enumeration date
07/02/2008
Last updated
07/02/2008
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