Provider Demographics
NPI:1184725103
Name:BELILL, TIMOTHY (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BELILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 TRAXLER CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9600
Mailing Address - Country:US
Mailing Address - Phone:989-686-2419
Mailing Address - Fax:989-686-2942
Practice Address - Street 1:3941 TRAXLER CT
Practice Address - Street 2:SUITE 400
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9600
Practice Address - Country:US
Practice Address - Phone:989-686-2419
Practice Address - Fax:989-686-2942
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P14990Medicare PIN
MI0P00590Medicare PIN