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General NPI Number Information
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NPI Number | 1801673066
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Entity Type | Organization
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Legal Business Name | BISH & LEGACY PHYSICAL THERAPY AND CANINE REHABILITATION LLC
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 297 EVANS CITY RD
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City | BUTLER
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State | PA
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Zip | 16001-2754
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Country | US
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Telephone | 814-227-8690
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Fax |
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Provider Business Mailing Address
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Address Line | 385 SARVER RD
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City | SARVER
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State | PA
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Zip | 16055-9715
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Country | US
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Telephone | 814-227-8690
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | RANDY DOUGLAS BISH
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Credential | DPT
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Telephone | 814-227-8690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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