Provider Demographics
NPI:1659625630
Name:BELLIS, LOU ANN
Entity Type:Individual
Prefix:
First Name:LOU ANN
Middle Name:
Last Name:BELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3121
Mailing Address - Country:US
Mailing Address - Phone:772-569-6375
Mailing Address - Fax:772-299-7868
Practice Address - Street 1:2965 20TH STREET
Practice Address - Street 2:ADVANCED MOTION THERAPEUTIC MASSAGE, INC.
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3097
Practice Address - Country:US
Practice Address - Phone:772-567-8585
Practice Address - Fax:772-299-7868
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9707224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant