MEDICARE: MS. JOANNE RUTH BELLOW LMBT

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	174400000X	Specialist	MA47425	FL
2	225700000X	Massage Therapist	MA47425	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376720300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANNE RUTH BELLOW LMBT

Provider Business Mailing Address
First Line	:	13024 YALE BLUFF DR
Second Line	:
City	:	GRAND ISLAND
State	:	FL
Zip	:	32735-8956
Country	:	US
Telephone Number	:	352-638-0391
Fax Number	:

Provider Business Practice Location Address
First Line	:	17521 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6737
Country	:	US
Telephone Number	:	352-638-0391
Fax Number	:

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

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	10/19/2018

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