Provider Demographics
NPI:1942967054
Name:BISHOP, KIRSTEN MIKELL (DPT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MIKELL
Last Name:BISHOP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MONTARA DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1510
Mailing Address - Country:US
Mailing Address - Phone:760-574-8974
Mailing Address - Fax:
Practice Address - Street 1:1011 RANCHO CONEJO BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1718
Practice Address - Country:US
Practice Address - Phone:844-518-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist