Provider Demographics
NPI:1538445994
Name:SISON, THOMAS (PT, DPT, MTC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SISON
Suffix:
Gender:M
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S MERIDITH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2825
Mailing Address - Country:US
Mailing Address - Phone:240-485-4450
Mailing Address - Fax:
Practice Address - Street 1:1111 N BRAND BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3070
Practice Address - Country:US
Practice Address - Phone:818-244-0468
Practice Address - Fax:818-244-7559
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist