Provider Demographics
NPI:1407983661
Name:BELLAMY, ALPHONZA (AT,C)
Entity Type:Individual
Prefix:MR
First Name:ALPHONZA
Middle Name:
Last Name:BELLAMY
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47178 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-1864
Mailing Address - Country:US
Mailing Address - Phone:248-431-4087
Mailing Address - Fax:
Practice Address - Street 1:222 REPUBLIC DR
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-3650
Practice Address - Country:US
Practice Address - Phone:313-216-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer