Provider Demographics
NPI:1356097281
Name:HISSOM, ELIZABETH PAIGE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PAIGE
Last Name:HISSOM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:PAIGE
Other - Last Name:HISSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1818 JEANNE ST
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1606
Mailing Address - Country:US
Mailing Address - Phone:616-335-1338
Mailing Address - Fax:
Practice Address - Street 1:3181 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9425
Practice Address - Country:US
Practice Address - Phone:517-336-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501301883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist