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General NPI Number Information
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NPI Number | 1003438094
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Entity Type | Individual
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Provider Name | BRET CORY BISHOP PTA
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Gender | Male
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 9208 GRAND CORDERA PKWY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-7022
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Country | US
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Telephone | 719-522-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 113 COMANCHE CT
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City | FOUNTAIN
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State | CO
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Zip | 80817-1693
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Country | US
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Telephone | 435-310-0841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.0014491
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | NHA.0003063
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License Number State | CO
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