1205158912 NPI number — BECCA MAE BELLAMY LAT, ATC, LMT

Table of content: BECCA MAE BELLAMY LAT, ATC, LMT (NPI 1205158912)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205158912 NPI number — BECCA MAE BELLAMY LAT, ATC, LMT

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
BELLAMY

Provider First Name:
BECCA

Provider Middle Name:
MAE

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
LAT, ATC, LMT

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205158912

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
02/19/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3607 W KIERNAN AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
SPOKANE

Provider Business Mailing Address State Name:
WA

Provider Business Mailing Address Postal Code:
99205-2141

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
509-941-3949

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1334 N WHITMAN LN STE 100

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
LIBERTY LAKE

Provider Business Practice Location Address State Name:
WA

Provider Business Practice Location Address Postal Code:
99019-6034

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
509-927-1222

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
02/22/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 225700000X , with the licence number: MA 60049086 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 2255A2300X , with the licence number: 60888426 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .