Basic Information
Provider Information
NPI: 1003295346
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BISHOP
FirstName: KAREN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 410 2ND AVE
Address2:  
City: PLATTSMOUTH
State: NE
PostalCode: 680482146
CountryCode: US
TelephoneNumber: 4023129212
FaxNumber:  
Practice Location
Address1: 4112 OUTLOOK BLVD
Address2: STE 96
City: PUEBLO
State: CO
PostalCode: 810081667
CountryCode: US
TelephoneNumber: 7192661788
FaxNumber: 7197764700
Other Information
ProviderEnumerationDate: 05/19/2015
LastUpdateDate: 05/19/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X0013256COY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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