Provider Demographics
NPI:1720300700
Name:BISHOP, KEVIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BISHOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N CHARLES G SEIVERS BLVD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3946
Mailing Address - Country:US
Mailing Address - Phone:865-766-5194
Mailing Address - Fax:
Practice Address - Street 1:1115 N CHARLES G SEIVERS BLVD
Practice Address - Street 2:SUITE 22
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3946
Practice Address - Country:US
Practice Address - Phone:865-766-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000000373225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant