MEDICARE: JENNIFER IRENE BELOTE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3826	TN

General Provider Information

NPI Number	:	1518041011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER IRENE BELOTE PTA

Provider Business Mailing Address
First Line	:	667 LOCK 4 RD
Second Line	:
City	:	GALLATIN
State	:	TN
Zip	:	37066-3432
Country	:	US
Telephone Number	:	615-330-2952
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 CASTLE HEIGHTS AVE N STE G
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-1512
Country	:	US
Telephone Number	:	615-443-4938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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