MEDICARE: MRS. JENNIFER L. BISHOP P.T.A.

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1477788800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER L. BISHOP P.T.A.

Provider Business Mailing Address
First Line	:	9310 MAPLE ST
Second Line	:
City	:	NEW LOTHROP
State	:	MI
Zip	:	48460-9811
Country	:	US
Telephone Number	:	810-638-2065
Fax Number	:

Provider Business Practice Location Address
First Line	:	9310 MAPLE ST
Second Line	:
City	:	NEW LOTHROP
State	:	MI
Zip	:	48460-9811
Country	:	US
Telephone Number	:	810-638-2065
Fax Number	:

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

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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Directions to “ MRS. JENNIFER L. BISHOP P.T.A.” Practice Location

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