Provider Demographics
NPI:1770838609
Name:BISHOP, VERONICA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:BOLUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:586 LONE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8170
Mailing Address - Country:US
Mailing Address - Phone:843-884-7880
Mailing Address - Fax:843-884-6635
Practice Address - Street 1:330 E 5TH NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-0702
Practice Address - Country:US
Practice Address - Phone:843-695-0326
Practice Address - Fax:843-695-0328
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8702Medicare PIN