Provider Demographics
NPI:1518588813
Name:BELGROD, ROBERT (LPAT, LCAT, ATR-BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BELGROD
Suffix:
Gender:M
Credentials:LPAT, LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 LOS ALTOS DE CICUYE
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552-2555
Mailing Address - Country:US
Mailing Address - Phone:808-366-9739
Mailing Address - Fax:
Practice Address - Street 1:76 LOS ALTOS DE CICUYE
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552-2555
Practice Address - Country:US
Practice Address - Phone:808-366-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002152221700000X
NMCAT0208121221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist