Provider Demographics
NPI:1518142850
Name:CHUCK BELLAH PHYSICAL THERAPIST, PC
Entity Type:Organization
Organization Name:CHUCK BELLAH PHYSICAL THERAPIST, PC
Other - Org Name:REHAB HOUSE CALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BELLAH
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:951-265-5245
Mailing Address - Street 1:39654 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5306
Mailing Address - Country:US
Mailing Address - Phone:951-265-5245
Mailing Address - Fax:951-461-2191
Practice Address - Street 1:39654 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5306
Practice Address - Country:US
Practice Address - Phone:951-265-5245
Practice Address - Fax:951-461-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17722261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy