Basic Information
| Provider Information | |||||||||
| NPI: | 1881148963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISH | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 MULBERRY LN | ||||||||
| Address2: | |||||||||
| City: | SLIPPERY ROCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160571002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142278690 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3053 NEW GERMANY RD | ||||||||
| Address2: | |||||||||
| City: | EBENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159313516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144721100 | ||||||||
| FaxNumber: | 8144726445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2016 | ||||||||
| LastUpdateDate: | 08/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT025305 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.