Healthcare Provider Details

I. General information

NPI: 1710347414
Provider Name (Legal Business Name): MICHAEL BISHOP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 TEMPLETON GAP RD
COLORADO SPRINGS CO
80907-7100
US

IV. Provider business mailing address

2107 TEMPLETON GAP RD
COLORADO SPRINGS CO
80907-7100
US

V. Phone/Fax

Practice location:
  • Phone: 719-271-4180
  • Fax: 719-247-8617
Mailing address:
  • Phone: 719-271-4180
  • Fax: 719-247-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: