Provider Demographics
NPI:1275087645
Name:WELLMAN, KATHRYN (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 VITTUM RD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-4103
Mailing Address - Country:US
Mailing Address - Phone:207-992-4000
Mailing Address - Fax:207-669-8302
Practice Address - Street 1:14 VITTUM RD
Practice Address - Street 2:BUILDING 1
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-4103
Practice Address - Country:US
Practice Address - Phone:207-992-4000
Practice Address - Fax:207-669-8302
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist