Provider Demographics
NPI:1235530973
Name:BISH, JEAN KELLY (DPT)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:KELLY
Last Name:BISH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:JEAN
Other - Middle Name:MARGARET
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:318 S NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-1446
Mailing Address - Country:US
Mailing Address - Phone:910-285-1799
Mailing Address - Fax:910-285-1899
Practice Address - Street 1:318 S NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1446
Practice Address - Country:US
Practice Address - Phone:910-285-1799
Practice Address - Fax:910-285-1899
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NC15141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist