MEDICARE: ANN MARIE BISHOP P.T.

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	864	WV
2	225100000X	Physical Therapist	13661	NC

General Provider Information

NPI Number	:	1952589178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE BISHOP P.T.

Provider Business Mailing Address
First Line	:	1900 WEBSTER RD
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-1034
Country	:	US
Telephone Number	:	304-872-6353
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 S CAMPBELL ST
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-5011
Country	:	US
Telephone Number	:	910-300-6424
Fax Number	:	910-300-6425

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	07/31/2012

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