=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528598828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER B BISHOP PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2017
-----------------------------------------------------
Last Update Date | 06/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 870 N ELLINGTON PKWY
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37091-2271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-359-1913
-----------------------------------------------------
Fax | 931-359-1932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6397 LEE HWY STE 300
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-2564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-238-8930
-----------------------------------------------------
Fax | 423-254-5217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 11357
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------