Provider Demographics
NPI:1801443007
Name:BELLEDONNE, KELLIE (PT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:BELLEDONNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E GATE LN
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2230
Mailing Address - Country:US
Mailing Address - Phone:617-827-8269
Mailing Address - Fax:
Practice Address - Street 1:1204 MAIN ST # 815
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3787
Practice Address - Country:US
Practice Address - Phone:203-518-8447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist