Provider Demographics
NPI:1336713155
Name:BISHOP, BROOKE RENEE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:RENEE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 BALMORAL DR SW STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5633
Mailing Address - Country:US
Mailing Address - Phone:256-617-5938
Mailing Address - Fax:256-883-1336
Practice Address - Street 1:4240 BALMORAL DR SW STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5633
Practice Address - Country:US
Practice Address - Phone:256-617-5938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-1137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist