MEDICARE: MR. BRETT L BISHOP MPT, OCS

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	2251X0800X	Orthopedic Physical Therapist	LPT-30754	AZ

General Provider Information

NPI Number	:	1396737987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRETT L BISHOP MPT, OCS

Provider Business Mailing Address
First Line	:	4175 S ALAMO AVE
Second Line	:	355TH MEDICAL GROUP
City	:	TUCSON
State	:	AZ
Zip	:	85707
Country	:	US
Telephone Number	:	520-228-2886
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 S ALAMO AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85707
Country	:	US
Telephone Number	:	520-228-2886
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/21/2023

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