Provider Demographics
NPI:1255652913
Name:WELLS, JESSICA (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2103C OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-4137
Mailing Address - Country:US
Mailing Address - Phone:870-248-1448
Mailing Address - Fax:870-248-1450
Practice Address - Street 1:2103C OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-4137
Practice Address - Country:US
Practice Address - Phone:870-248-1448
Practice Address - Fax:870-248-1450
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant