Healthcare Provider Details

I. General information

NPI: 1003295346
Provider Name (Legal Business Name): KAREN BISHOP DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 OUTLOOK BLVD STE 96
PUEBLO CO
81008-1667
US

IV. Provider business mailing address

410 2ND AVE
PLATTSMOUTH NE
68048-2146
US

V. Phone/Fax

Practice location:
  • Phone: 719-266-1788
  • Fax: 719-776-4700
Mailing address:
  • Phone: 402-312-9212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0013256
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: