Provider Demographics
NPI:1518041011
Name:BELOTE, JENNIFER IRENE (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRENE
Last Name:BELOTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 LOCK 4 RD
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3432
Mailing Address - Country:US
Mailing Address - Phone:615-330-2952
Mailing Address - Fax:
Practice Address - Street 1:404 CASTLE HEIGHTS AVE N STE G
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1512
Practice Address - Country:US
Practice Address - Phone:615-443-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3826225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant