Provider Demographics
NPI:1558842229
Name:BISHOP, GREGORY (PT, DPT, GCS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PT, DPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 LUCAS RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-6623
Mailing Address - Country:US
Mailing Address - Phone:910-891-4600
Mailing Address - Fax:910-230-0506
Practice Address - Street 1:604 LUCAS RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6623
Practice Address - Country:US
Practice Address - Phone:910-891-4600
Practice Address - Fax:910-230-0506
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist