Provider Demographics
NPI:1164531653
Name:WELLING, DENNIS DRAKE I (PT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DRAKE
Last Name:WELLING
Suffix:I
Gender:M
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:PO BOX 218204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-8204
Mailing Address - Country:US
Mailing Address - Phone:315-646-3669
Mailing Address - Fax:615-373-7116
Practice Address - Street 1:210 25TH AVE NORTH
Practice Address - Street 2:520
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1801
Practice Address - Country:US
Practice Address - Phone:615-321-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5591OtherLICENSE #