Provider Demographics
NPI:1467475624
Name:BISHOP, DANIEL A (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 US HWY 98
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:US
Mailing Address - Phone:251-626-7778
Mailing Address - Fax:251-626-7780
Practice Address - Street 1:1203 US HWY 98
Practice Address - Street 2:SUITE 1-C
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-626-7778
Practice Address - Fax:251-626-7780
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890013910Medicaid
AL515-30296OtherBCBS
AL051554965Medicare ID - Type Unspecified