Provider Demographics
NPI:1376045039
Name:BISHOP, BARBARA DANA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:DANA
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7445 ALLEN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1992
Mailing Address - Country:US
Mailing Address - Phone:313-389-5600
Mailing Address - Fax:313-389-0288
Practice Address - Street 1:7445 ALLEN RD STE 102
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1992
Practice Address - Country:US
Practice Address - Phone:313-389-5600
Practice Address - Fax:313-389-0288
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist