Healthcare Provider Details

I. General information

NPI: 1710902051
Provider Name (Legal Business Name): ELIJAH JERAE BISHOP III PT MPT OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 E TACHEVAH DR STE 107
PALM SPRINGS CA
92262-7402
US

IV. Provider business mailing address

79865 CIEGO DR
BERMUDA DUNES CA
92203-1454
US

V. Phone/Fax

Practice location:
  • Phone: 760-459-0003
  • Fax: 760-656-0614
Mailing address:
  • Phone: 818-731-0317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: