Provider Demographics
NPI:1053847137
Name:BELSON, EMILY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BELSON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27822 COUNTRY LANE RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3768
Mailing Address - Country:US
Mailing Address - Phone:949-330-9094
Mailing Address - Fax:
Practice Address - Street 1:338 LANGSTON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2478
Practice Address - Country:US
Practice Address - Phone:949-330-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0029942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer