Individual
MISS FARRAH MANANTAN SISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3290 NORTH RIDGE RD, SUITE 290 EXECUTIVE CENTER BLDG, ELLICOTT CITY, MD 21043
(240) 328-9670
Mailing address
3290 N RIDGE RD, SUITE 290 EXECUTIVE CENTER BUILDING, ELLICOTT CITY, MD 21043-3655
(240) 328-9670
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
22674
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97775558
US ALIEN NUMBER
—
Enumeration date
11/06/2008
Last updated
11/06/2008
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