MEDICARE: KATHLEEN MARIE BISHOP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	R1400	MO

General Provider Information

NPI Number	:	1396413050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARIE BISHOP

Provider Business Mailing Address
First Line	:	5101 S TIERNEY DR
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6940
Country	:	US
Telephone Number	:	816-550-1906
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 NE NAPOLEON
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-5403
Country	:	US
Telephone Number	:	816-228-8866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	08/30/2021

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