Provider Demographics
NPI:1700814597
Name:BELLONE, JULIE S (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:S
Last Name:BELLONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:FRANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1282 WATERLOO GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1208
Mailing Address - Country:US
Mailing Address - Phone:315-539-4683
Mailing Address - Fax:315-539-4684
Practice Address - Street 1:1282 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1208
Practice Address - Country:US
Practice Address - Phone:315-539-4683
Practice Address - Fax:315-539-4684
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0123181208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC6036Medicare ID - Type Unspecified