Provider Demographics
NPI:1497368799
Name:BELLO, JESSICA ANDREA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANDREA
Last Name:BELLO
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 1:333 STATE ST APT 205
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4800
Mailing Address - Country:US
Mailing Address - Phone:203-747-1941
Mailing Address - Fax:
Practice Address - Street 1:3585 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4103
Practice Address - Country:US
Practice Address - Phone:203-380-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist