Provider Demographics
NPI:1093084188
Name:BISHOP, MICHAEL CORDON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CORDON
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 FAULKNER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-9129
Mailing Address - Country:US
Mailing Address - Phone:805-749-2273
Mailing Address - Fax:
Practice Address - Street 1:957 FAULKNER RD STE 105
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-9129
Practice Address - Country:US
Practice Address - Phone:805-749-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist