Basic Information
| Provider Information | |||||||||
| NPI: | 1275904336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELZER | ||||||||
| FirstName: | JEANNETTE | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1283 W DUNDEE RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600894009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476329919 | ||||||||
| FaxNumber: | 7733379106 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 S ROUTE 31 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600505415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153441192 | ||||||||
| FaxNumber: | 7733379106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 10/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 227006362 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.