Provider Demographics
NPI:1841458429
Name:BELLIS, JENNIFER DAWN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:BELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 OLD ANNETTA RD
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-3849
Mailing Address - Country:US
Mailing Address - Phone:210-260-6252
Mailing Address - Fax:888-846-5621
Practice Address - Street 1:1093 OLD ANNETTA RD
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-3849
Practice Address - Country:US
Practice Address - Phone:210-260-6252
Practice Address - Fax:888-846-5621
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist