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NPI Code Detail

MEDICARE: DAKOTA BELLISTON

MEDICARE: DAKOTA BELLISTON
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
1225200000XPhysical Therapy Assistant7673502-2402UT

General Provider Information

NPI Number : 1871094383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAKOTA BELLISTON
Provider Business Mailing Address
First Line : 206 N 2100 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84116-4740
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3855 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1157
Country : US
Telephone Number : 801-268-4766
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2018
Last Update Date : 02/21/2018

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Directions to “ DAKOTA BELLISTON ” Practice Location

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