Provider Demographics
NPI:1164431334
Name:BELLEW, PETER OWEN (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:OWEN
Last Name:BELLEW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40192
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0192
Mailing Address - Country:US
Mailing Address - Phone:602-430-2128
Mailing Address - Fax:
Practice Address - Street 1:2222 S DOBSON RD
Practice Address - Street 2:SUITE 305
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6481
Practice Address - Country:US
Practice Address - Phone:480-838-5553
Practice Address - Fax:480-838-3347
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2007-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist