Provider Demographics
NPI:1063137255
Name:BELO, TAYLOR N (PTA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:N
Last Name:BELO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3179
Mailing Address - Country:US
Mailing Address - Phone:815-344-4499
Mailing Address - Fax:815-344-4779
Practice Address - Street 1:3922 MERCY DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3179
Practice Address - Country:US
Practice Address - Phone:815-344-4499
Practice Address - Fax:815-344-4779
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-009629225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant