Provider Demographics
NPI:1740559863
Name:BELLCASE, LINDSEY
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BELLCASE
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 1:520 E 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6208
Mailing Address - Country:US
Mailing Address - Phone:706-513-0966
Mailing Address - Fax:
Practice Address - Street 1:520 E 8TH ST SE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6208
Practice Address - Country:US
Practice Address - Phone:706-513-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2020-02-07
Deactivation Date:2020-01-28
Deactivation Code:
Reactivation Date:2020-02-06
Provider Licenses
StateLicense IDTaxonomies
GAPT012956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05355594Medicaid