Provider Demographics
NPI:1003483603
Name:BISHOP, MICHAEL JOSEPH (DPT, C-PS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DPT, C-PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9016 RIATO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121
Mailing Address - Country:US
Mailing Address - Phone:505-974-1306
Mailing Address - Fax:
Practice Address - Street 1:601 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4502
Practice Address - Country:US
Practice Address - Phone:505-425-2998
Practice Address - Fax:505-425-2897
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT4085261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy