Provider Demographics
NPI:1710421342
Name:BELVIS, PETER (PTA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:BELVIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11349 AVENIDA DE LOS LOBOS
Mailing Address - Street 2:UNIT H
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5892
Mailing Address - Country:US
Mailing Address - Phone:240-993-6285
Mailing Address - Fax:
Practice Address - Street 1:3884 NOBEL DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5700
Practice Address - Country:US
Practice Address - Phone:858-625-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11187225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant