Provider Demographics
NPI:1689142200
Name:BELLANICH, JEFFREY P (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:BELLANICH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 CHRISTIE AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1934
Mailing Address - Country:US
Mailing Address - Phone:510-529-7550
Mailing Address - Fax:510-529-7551
Practice Address - Street 1:5901 CHRISTIE AVE STE 305
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1934
Practice Address - Country:US
Practice Address - Phone:510-529-7550
Practice Address - Fax:510-529-7551
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
CA301989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist