Provider Demographics
NPI:1760771216
Name:BELLVILLE, CHARLES ANTHONY (LMT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:BELLVILLE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:BELLVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1112 E DUNEDIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3306
Mailing Address - Country:US
Mailing Address - Phone:614-638-5067
Mailing Address - Fax:
Practice Address - Street 1:3400 N HIGH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1142
Practice Address - Country:US
Practice Address - Phone:614-638-5067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.007447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist