Provider Demographics
NPI:1063290179
Name:BELLA BUZZ LLC
Entity type:Organization
Organization Name:BELLA BUZZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:W
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:509-540-4889
Mailing Address - Street 1:609 TOUCHET NORTH RD
Mailing Address - Street 2:
Mailing Address - City:TOUCHET
Mailing Address - State:WA
Mailing Address - Zip Code:99360-9537
Mailing Address - Country:US
Mailing Address - Phone:509-540-4889
Mailing Address - Fax:
Practice Address - Street 1:1220 W POPLAR ST STE A
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2757
Practice Address - Country:US
Practice Address - Phone:509-540-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty