Provider Demographics
NPI:1457585150
Name:BELLOSPIRITO, JILL A (LMT)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:A
Last Name:BELLOSPIRITO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 CALLE MEJIA
Mailing Address - Street 2:UNIT 1105
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1492
Mailing Address - Country:US
Mailing Address - Phone:978-500-8229
Mailing Address - Fax:
Practice Address - Street 1:941 CALLE MEJIA
Practice Address - Street 2:UNIT 1105
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1492
Practice Address - Country:US
Practice Address - Phone:978-500-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5542225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist