Individual
BLAKE THOMAS SISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-2723
(507) 284-2511
Mailing address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4031
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2727
MN
363A00000X
Physician Assistant
0010-15560
NC
363A00000X
Physician Assistant
Primary
14420
MN
363A00000X
Physician Assistant
—
MN
Other
Enumeration date
07/07/2016
Last updated
02/26/2026
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