Provider Demographics
NPI:1063055424
Name:SISSON, CRISTEN (BS, MPT)
Entity type:Individual
Prefix:
First Name:CRISTEN
Middle Name:
Last Name:SISSON
Suffix:
Gender:F
Credentials:BS, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 MASON LEE PL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8636
Mailing Address - Country:US
Mailing Address - Phone:470-589-8118
Mailing Address - Fax:
Practice Address - Street 1:3581 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1065
Practice Address - Country:US
Practice Address - Phone:770-800-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist