Provider Demographics
NPI:1154442853
Name:WELLS, ANDREA F (LMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:F
Last Name:WELLS
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 1:1599 NEWPORT LOOP N
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8177
Mailing Address - Country:US
Mailing Address - Phone:614-871-7674
Mailing Address - Fax:614-871-7674
Practice Address - Street 1:136 MILL ST
Practice Address - Street 2:SUITE 120
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3059
Practice Address - Country:US
Practice Address - Phone:614-472-0992
Practice Address - Fax:614-472-0994
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11712174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist