Provider Demographics
NPI:1114097805
Name:WELLS, JANIS A (PT)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DANA DR
Mailing Address - Street 2:
Mailing Address - City:NEW WAVERLY
Mailing Address - State:TX
Mailing Address - Zip Code:77358
Mailing Address - Country:US
Mailing Address - Phone:979-285-5571
Mailing Address - Fax:844-364-2660
Practice Address - Street 1:30 DANA DR
Practice Address - Street 2:
Practice Address - City:NEW WAVERLY
Practice Address - State:TX
Practice Address - Zip Code:77358
Practice Address - Country:US
Practice Address - Phone:979-285-5571
Practice Address - Fax:844-364-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000835OtherMEDICARE GROUP #
TX83517EMedicare ID - Type Unspecified
TX83878EMedicare UPIN