Basic Information
| Provider Information | |||||||||
| NPI: | 1912920877 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLEW | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3730 BLAIR DR | ||||||||
| Address2: | LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONS | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711034602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186322030 | ||||||||
| FaxNumber: | 3186755666 | ||||||||
| Practice Location | |||||||||
| Address1: | 3730 BLAIR DR | ||||||||
| Address2: | LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONS | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711034602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186322030 | ||||||||
| FaxNumber: | 3186755666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1174173 | 05 | LA | MEDICAID |