Provider Demographics
NPI:1144053059
Name:BISHOP, TEAH ANDREA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:TEAH
Middle Name:ANDREA
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4458 LAKE SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5800
Mailing Address - Country:US
Mailing Address - Phone:361-585-9933
Mailing Address - Fax:
Practice Address - Street 1:4646 CORONA DR STE 172
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4361
Practice Address - Country:US
Practice Address - Phone:361-585-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129443225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist