Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1699099606 |
---|---|
Provider Name | Mr. Matthew Allen Bishop |
First Address | Rigby, ID 83442-5073 |
Second Address | Idaho Falls, ID 83404-6375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2010 |
Last Update Date | 19/03/2010 |