Provider Demographics
NPI:1174944763
Name:BELL, CHARLES BENJAMIN JR (ATC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BENJAMIN
Last Name:BELL
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 GROVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7209
Mailing Address - Country:US
Mailing Address - Phone:727-686-0201
Mailing Address - Fax:
Practice Address - Street 1:22043 US 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2363
Practice Address - Country:US
Practice Address - Phone:727-692-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL31982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer