MEDICARE: CARL C BELLE RPT

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	225100000X	Physical Therapist	1727	CO

General Provider Information

NPI Number	:	1326121625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL C BELLE RPT

Provider Business Mailing Address
First Line	:	6595 S DAYTON ST
Second Line	:	SUITE 1500
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-6128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3464 S WILLOW ST
Second Line	:	SUITE 511
City	:	DENVER
State	:	CO
Zip	:	80231-4531
Country	:	US
Telephone Number	:	303-755-2900
Fax Number	:

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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