Provider Demographics
NPI:1346787348
Name:WELLS, KRISTI RAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:RAE
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:RAE
Other - Last Name:CARAGLIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1630 SW MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1916
Mailing Address - Country:US
Mailing Address - Phone:503-227-7774
Mailing Address - Fax:503-227-7548
Practice Address - Street 1:1902 ROMULUS ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2022
Practice Address - Country:US
Practice Address - Phone:504-400-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62054225100000X
LA09004R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist