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NPI Code Detail

MEDICARE: BROCK BISHOP

MEDICARE: BROCK 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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1750959136
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROCK BISHOP
Provider Business Mailing Address
First Line : 805 SE 3RD AVE STE 2
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33316-1193
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 805 SE 3RD AVE STE 2
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33316-1193
Country : US
Telephone Number : 954-256-9052
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2021
Last Update Date : 06/14/2021

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Directions to “ BROCK BISHOP ” Practice Location

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