Provider Demographics
NPI:1093409617
Name:BELLMON-COOPER, NAJIYYAH JAMILAH
Entity Type:Individual
Prefix:
First Name:NAJIYYAH
Middle Name:JAMILAH
Last Name:BELLMON-COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 CROSSCUT LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4060
Mailing Address - Country:US
Mailing Address - Phone:737-742-1867
Mailing Address - Fax:
Practice Address - Street 1:4515 S MCCLINTOCK DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7376
Practice Address - Country:US
Practice Address - Phone:737-742-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)