Provider Demographics
NPI:1598090953
Name:BELYEA, SAM (LMT)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:BELYEA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1936 BRUCE B DOWNS BLVD
Mailing Address - Street 2:# 112
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9262
Mailing Address - Country:US
Mailing Address - Phone:813-650-6437
Mailing Address - Fax:813-200-3474
Practice Address - Street 1:3420 S DALE MABRY HWY
Practice Address - Street 2:SUITE N
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8638
Practice Address - Country:US
Practice Address - Phone:813-831-9420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#56213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist