Provider Demographics
NPI:1770802282
Name:BISHOP, RYAN (LAC, LMT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:BISHOP
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 CARAMBOLA CIR S
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2560
Mailing Address - Country:US
Mailing Address - Phone:561-707-8451
Mailing Address - Fax:954-979-3841
Practice Address - Street 1:13005 SOUTHERN BLVD.,
Practice Address - Street 2:SUITE 225 ANKLE & FOOT CENTRE OF SOUTH FL.
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-707-8451
Practice Address - Fax:954-979-3841
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3223171100000X
FLMA35463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP 3223OtherFLORIDA DEPARTMENT OF HEALTH BOARD OF ACUPUNCTURE
FLMA35463OtherSTATE OF FLORIDA LICENSE NUMBER