Individual
KYLE ERIC BISHOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT,ATC,BS
Contact information
Practice address
754 LUETKENHAUS BLVD, WENTZVILLE, MO 63385-3515
(636) 445-5001
Mailing address
3812 HOPEWELL RD, WENTZVILLE, MO 63385-5924
(636) 887-6674
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2021027368
MO
Other
Enumeration date
02/28/2020
Last updated
12/30/2021
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