Provider Demographics
NPI:1366786717
Name:BELLOMO, WILLIAM GEORGE II (PTA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GEORGE
Last Name:BELLOMO
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:BELLOMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:39343 AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5505
Mailing Address - Country:US
Mailing Address - Phone:586-419-4362
Mailing Address - Fax:
Practice Address - Street 1:39343 AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-5505
Practice Address - Country:US
Practice Address - Phone:586-419-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003698225200000X
MI7501003114225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant