Provider Demographics
NPI:1225439680
Name:BELLAMY, KATI (PT)
Entity Type:Individual
Prefix:
First Name:KATI
Middle Name:
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 AMARILLO ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-5702
Mailing Address - Country:US
Mailing Address - Phone:870-532-2229
Mailing Address - Fax:870-532-8237
Practice Address - Street 1:4407 AMARILLO ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-5702
Practice Address - Country:US
Practice Address - Phone:870-532-2229
Practice Address - Fax:870-532-8237
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10126R225100000X
AR3818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR203524721Medicaid