Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | PT026146 | PA |
N | 213ES0000X | Sports Medicine | PT026146 | PA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT026146 | PA |
NPI | 1467019968 |
---|---|
Provider Name | Heather Bellum |
First Address | Bloomsburg, PA 17815 |
Second Address | Shamokin, PA 17872-6754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 07/10/2020 |