Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1157250 | TX |
NPI | 1023075629 |
---|---|
Provider Name | Mr. Michael David Bishop |
First Address | Austin, TX 78757-7862 |
Second Address | Austin, TX 78713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |