Provider Demographics
NPI:1114213196
Name:BELLM, ERIC (DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BELLM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1853
Mailing Address - Country:US
Mailing Address - Phone:847-441-5788
Mailing Address - Fax:847-784-8720
Practice Address - Street 1:852 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1853
Practice Address - Country:US
Practice Address - Phone:847-441-5788
Practice Address - Fax:847-784-8720
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110195902251S0007X
IL070-019688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports