Provider Demographics
NPI:1871570754
Name:BISHOP, MICHAEL BRUCE (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRUCE
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:STE. 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:4040 ORCHARD ST W
Practice Address - Street 2:STE. 100
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6606
Practice Address - Country:US
Practice Address - Phone:253-564-1560
Practice Address - Fax:253-564-4449
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7123367Medicaid
WAG8914603Medicare PIN
WAG8914602Medicare PIN