Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | 10358 | MA |
Y | 2251P0200X | Physical Therapist - Pediatrics | 10358 | MA |
NPI | 1326490749 |
---|---|
Provider Name | Mrs. Leanne M. Bishop |
First Address | Fairhaven, MA 02719-2923 |
Second Address | Fairhaven, MA 02719-2923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2016 |
Last Update Date | 29/08/2016 |