Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 226300000X | Kinesiotherapist |
NPI | 1376730077 |
---|---|
Provider Name | Ms. Susan Diane Bishop |
First Address | Edmond, OK 73025-2305 |
Second Address | Edmond, OK 73025-2305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 27/09/2007 |