Provider Demographics
NPI:1598961781
Name:BELOUD, SEAN (MS, PTA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BELOUD
Suffix:
Gender:M
Credentials:MS, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 STANFORD RANCH RD STE 2
Mailing Address - Street 2:SUITE 134
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5554
Mailing Address - Country:US
Mailing Address - Phone:916-295-8662
Mailing Address - Fax:
Practice Address - Street 1:135 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2701
Practice Address - Country:US
Practice Address - Phone:916-295-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 4092225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant