Provider Demographics
NPI:1760600860
Name:BISHOP, PAULA (MSPT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1831
Mailing Address - Country:US
Mailing Address - Phone:860-748-6672
Mailing Address - Fax:
Practice Address - Street 1:1157 HIGHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1600
Practice Address - Country:US
Practice Address - Phone:203-271-9288
Practice Address - Fax:203-271-9817
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0039032251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics