Provider Demographics
NPI:1447405303
Name:HOSTAK, BELLA (PT,DPT,GCS,CEEAA,CCI)
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:HOSTAK
Suffix:
Gender:F
Credentials:PT,DPT,GCS,CEEAA,CCI
Other - Prefix:
Other - First Name:BELLA
Other - Middle Name:
Other - Last Name:GOPLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT,GCS,CEEAA,CCI
Mailing Address - Street 1:650 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-4030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-239-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
MAPT18891225100000X
MNPT9501225100000X
MA18891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist