Provider Demographics
NPI:1386868024
Name:WELLS, RENAE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:LYNN
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-9572
Mailing Address - Country:US
Mailing Address - Phone:317-392-1000
Mailing Address - Fax:317-392-1000
Practice Address - Street 1:673 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-9572
Practice Address - Country:US
Practice Address - Phone:317-392-1000
Practice Address - Fax:317-392-1000
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001218A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist