MEDICARE: JENNIFER BARNES BISHOP ATC, PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	12230	CO

General Provider Information

NPI Number	:	1609126754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BARNES BISHOP ATC, PTA

Provider Business Mailing Address
First Line	:	3522 HARTSEL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4165
Country	:	US
Telephone Number	:	719-535-2757
Fax Number	:	719-535-2767

Provider Business Practice Location Address
First Line	:	3522 HARTSEL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4165
Country	:	US
Telephone Number	:	719-535-2757
Fax Number	:	719-535-2767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	09/17/2012

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