1881856490 NPI number — MR. DONALD LEE BISHOP MA, ATC, LAT

Table of content: MR. DONALD LEE BISHOP MA, ATC, LAT (NPI 1881856490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881856490 NPI number — MR. DONALD LEE BISHOP MA, ATC, LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISHOP
Provider First Name:
DONALD
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, ATC, LAT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881856490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HUMAN PERFORMANCE CENTER 2351
Provider Second Line Business Mailing Address:
HUDSON ROAD
Provider Business Mailing Address City Name:
CEDAR FALLS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50614-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-273-6369
Provider Business Mailing Address Fax Number:
319-273-7023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HUMAN PERFORMANCE CENTER 2351
Provider Second Line Business Practice Location Address:
HUDSON ROAD
Provider Business Practice Location Address City Name:
CEDAR FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50614-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-273-6369
Provider Business Practice Location Address Fax Number:
319-273-7023
Provider Enumeration Date:
06/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  00074 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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