Provider Demographics
NPI:1508247412
Name:ROBELLO, BETSY (LMT)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:ROBELLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7242 W AURORA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9559
Mailing Address - Country:US
Mailing Address - Phone:623-276-2535
Mailing Address - Fax:
Practice Address - Street 1:7155 W CAMPO BELLO DR
Practice Address - Street 2:BLDG A - SUITE 12
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8590
Practice Address - Country:US
Practice Address - Phone:623-221-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist