Provider Demographics
NPI:1396012241
Name:BELYEU, JACOB EUGENE I (CMT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:EUGENE
Last Name:BELYEU
Suffix:I
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W LAKEWAY RD
Mailing Address - Street 2:D
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6146
Mailing Address - Country:US
Mailing Address - Phone:307-363-3519
Mailing Address - Fax:
Practice Address - Street 1:501 W LAKEWAY RD
Practice Address - Street 2:D
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6146
Practice Address - Country:US
Practice Address - Phone:307-363-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist