Provider Demographics
NPI:1861649741
Name:BISHOP, RYAN JACOB (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JACOB
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3896 N SCHREIBER WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8362
Mailing Address - Country:US
Mailing Address - Phone:208-666-6665
Mailing Address - Fax:208-475-7708
Practice Address - Street 1:3896 N SCHREIBER WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8362
Practice Address - Country:US
Practice Address - Phone:208-666-6665
Practice Address - Fax:208-475-7708
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60037722225100000X
IDPT-2952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist