Provider Demographics
NPI:1336458785
Name:BELLEVUE, MONA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:BELLEVUE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:MONPLAISIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:450 E. HWY. 50
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:CLEMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:321-946-2931
Mailing Address - Fax:321-285-8355
Practice Address - Street 1:450 E. HWY. 50
Practice Address - Street 2:SUITE 8A
Practice Address - City:CLEMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:321-946-2931
Practice Address - Fax:321-285-8355
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41638225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist