Provider Demographics
NPI:1194407908
Name:SISON, JORDAN ANGELA (DPT)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:ANGELA
Last Name:SISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUCKNER RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3308
Mailing Address - Country:US
Mailing Address - Phone:551-502-6445
Mailing Address - Fax:
Practice Address - Street 1:8 RUCKNER RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3308
Practice Address - Country:US
Practice Address - Phone:551-502-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02059600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist