Provider Demographics
NPI:1023596178
Name:BELLEFONTAINE, JANET SUE (PHYICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:SUE
Last Name:BELLEFONTAINE
Suffix:
Gender:F
Credentials:PHYICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 N CAMDEN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2883
Mailing Address - Country:US
Mailing Address - Phone:847-488-0120
Mailing Address - Fax:
Practice Address - Street 1:700 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1442
Practice Address - Country:US
Practice Address - Phone:847-204-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.007053261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy