Individual
MR. HENRY SISUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5669
MA
225100000X
Physical Therapist
Primary
PT00646
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1454-35-0001
DMERC ID #
RI
01
—
19016
NEIGHBORHOOD HEALTH PLAN
—
01
—
2015585
AETNA PROV ID#
RI
01
—
401280
RI BLUECHIP PROV #
RI
01
—
5669
PT LICENSE STATE OF MA
MA
01
—
5712442
AETNA INDIVIDUAL #
MA
01
—
605716
HPHC MA PROV ID#
MA
01
—
70151140002
CIGNA NON-PAR
—
01
—
7536
RI BCBS PROV #
RI
01
—
AA46223
HPHC RI PROV ID#
RI
01
—
PT00646
PT LICENSE # STATE OF RI
RI
01
—
PT0182
MEDICARE GROUP # OT SERV
MA
01
—
Y65737
MA BCBS PROV ID #
MA
Enumeration date
11/09/2005
Last updated
09/27/2011
Update your record
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