=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407188162
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA BELAMOUR PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2010
-----------------------------------------------------
Last Update Date | 02/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 ANSON STREET
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-883-4681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | POST OFFICE BOX 40
-----------------------------------------------------
City | HUNTINGBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-661-0385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 06003694A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------