Provider Demographics
NPI:1881148963
Name:BISH, RANDY DOUGLAS (DPT)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:DOUGLAS
Last Name:BISH
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 1:297 EVANS CITY RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2754
Mailing Address - Country:US
Mailing Address - Phone:724-841-0700
Mailing Address - Fax:724-923-4161
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:724-841-0700
Practice Address - Fax:724-923-4161
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-07
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist