Provider Demographics
NPI:1598090953
Name:BELYEA, SAMUEL (LMT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:BELYEA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 W SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629
Mailing Address - Country:US
Mailing Address - Phone:904-710-1547
Mailing Address - Fax:813-200-3474
Practice Address - Street 1:3406 W SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629
Practice Address - Country:US
Practice Address - Phone:904-710-1547
Practice Address - Fax:813-512-2734
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#56213225700000X
FLRBT-24-364433106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123325900Medicaid