Provider Demographics
NPI:1891542734
Name:BELLEW, JESSICA MELANCON (MPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MELANCON
Last Name:BELLEW
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BONAVENTURE WAY STE 167
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8007
Mailing Address - Country:US
Mailing Address - Phone:832-559-2900
Mailing Address - Fax:
Practice Address - Street 1:800 BONAVENTURE WAY STE 167
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8007
Practice Address - Country:US
Practice Address - Phone:832-559-2900
Practice Address - Fax:832-559-2900
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1148171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist