Provider Demographics
NPI:1265239230
Name:BELLIS-VANCE, MEGAN ANASTASIA (LMT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANASTASIA
Last Name:BELLIS-VANCE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANASTASIA
Other - Last Name:BELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1210 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-3521
Mailing Address - Country:US
Mailing Address - Phone:419-786-8470
Mailing Address - Fax:
Practice Address - Street 1:1210 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-3521
Practice Address - Country:US
Practice Address - Phone:419-786-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025870225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty