MEDICARE: BELLFORT WELLNESS CENTER INC.

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	261QP2000X	Physical Therapy Clinic/Center	666050000	TX

General Provider Information

NPI Number	:	1851523864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLFORT WELLNESS CENTER INC.

Provider Business Mailing Address
First Line	:	8527 W BELLFORT ST
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77071-2265
Country	:	US
Telephone Number	:	713-270-1777
Fax Number	:	713-270-1780

Provider Business Practice Location Address
First Line	:	8527 W BELLFORT ST
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77071-2265
Country	:	US
Telephone Number	:	713-270-1777
Fax Number	:	713-270-1780

Authorized Official
Title or Position	:	PRESIDENT
Name	:	L OBII AHAM-NEZE
Credential	:
Telephone Number	:	832-868-7757

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	08/10/2009

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