Healthcare Provider Details

I. General information

NPI: 1588024335
Provider Name (Legal Business Name): REBBECCA LYNN BISHOP CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBBECCA LYNN HOFFMAN CMT

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1897 E COLTON AVE INSIDE CROSSFIT EAST REDLANDS
REDLANDS CA
92374-9797
US

IV. Provider business mailing address

1721 E COLTON AVE SPC 118
REDLANDS CA
92374-4968
US

V. Phone/Fax

Practice location:
  • Phone: 909-353-7786
  • Fax:
Mailing address:
  • Phone: 909-674-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number53553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: