Provider Demographics
NPI:1851386809
Name:BELLO, JENI L (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENI
Middle Name:L
Last Name:BELLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:JENI
Other - Middle Name:A
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2061 VANGUARD DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2133
Mailing Address - Country:US
Mailing Address - Phone:805-388-1586
Mailing Address - Fax:
Practice Address - Street 1:2486 N PONDEROSA DR
Practice Address - Street 2:STE D106
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-484-5447
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT27689Medicare ID - Type Unspecified