Provider Demographics
NPI:1477788800
Name:BISHOP, JENNIFER L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW LOTHROP
Mailing Address - State:MI
Mailing Address - Zip Code:48460-9811
Mailing Address - Country:US
Mailing Address - Phone:810-638-2065
Mailing Address - Fax:
Practice Address - Street 1:9310 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NEW LOTHROP
Practice Address - State:MI
Practice Address - Zip Code:48460-9811
Practice Address - Country:US
Practice Address - Phone:810-638-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant