Provider Demographics
NPI:1508814542
Name:BELLITTI, ANDREA LEE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEE
Last Name:BELLITTI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2777 BRISTOL ST
Mailing Address - Street 2:STE B
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5997
Mailing Address - Country:US
Mailing Address - Phone:949-250-1112
Mailing Address - Fax:949-250-1401
Practice Address - Street 1:2777 BRISTOL ST
Practice Address - Street 2:STE B
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5997
Practice Address - Country:US
Practice Address - Phone:949-250-1112
Practice Address - Fax:949-250-1401
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT29598Medicare UPIN