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General NPI Number Information
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NPI Number | 1245442888
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Entity Type | Individual
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Provider Name | SANDY BELLER CANOUT O.T.,P.T.,C.F.P.,CHT
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1200 WILSHIRE BLVD SUITE 401
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City | LOS ANGELES
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State | CA
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Zip | 90017-1908
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Country | US
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Telephone | 213-481-1515
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Fax | 213-481-1518
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Provider Business Mailing Address
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Address Line | 3638 LEWIS AVE
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City | LONG BEACH
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State | CA
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Zip | 90807-4118
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Country | US
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Telephone | 562-426-9797
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Fax | 213-481-1518
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT12641
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT6574
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License Number State | CA
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