Provider Demographics
NPI:1801673066
Name:BISH & LEGACY PHYSICAL THERAPY AND CANINE REHABILITATION LLC
Entity type:Organization
Organization Name:BISH & LEGACY PHYSICAL THERAPY AND CANINE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:814-227-8690
Mailing Address - Street 1:385 SARVER RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9715
Mailing Address - Country:US
Mailing Address - Phone:814-227-8690
Mailing Address - Fax:
Practice Address - Street 1:297 EVANS CITY RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2754
Practice Address - Country:US
Practice Address - Phone:814-227-8690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty