Provider Demographics
NPI:1326258690
Name:WELLS, JESSICA NICOLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:KEITH
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 SW 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5235
Mailing Address - Country:US
Mailing Address - Phone:541-574-1823
Mailing Address - Fax:541-812-2070
Practice Address - Street 1:1111 SW 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5235
Practice Address - Country:US
Practice Address - Phone:541-574-1823
Practice Address - Fax:541-812-2070
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8367225100000X
OR63760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist