Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070-019688 | IL |
N | 2251S0007X | Physical Therapist - Sports | 2011019590 | MO |
NPI | 1114213196 |
---|---|
Provider Name | Eric Bellm |
First Address | Winnetka, IL 60093-1853 |
Second Address | Winnetka, IL 60093-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 29/01/2013 |