Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 31206 | FL |
NPI | 1003276940 |
---|---|
Provider Name | Jennifer Bishop |
First Address | Brandon, FL 33511-5509 |
Second Address | Brandon, FL 33511-5509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2016 |
Last Update Date | 04/03/2016 |