Provider Demographics
NPI:1407815764
Name:WELLMAN, MARC WESLEY (PT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:WESLEY
Last Name:WELLMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JEFFERSON TOWNSHIP PKWY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1704
Mailing Address - Country:US
Mailing Address - Phone:678-352-1642
Mailing Address - Fax:678-352-1642
Practice Address - Street 1:3900 JEFFERSON TOWNSHIP PKWY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-1704
Practice Address - Country:US
Practice Address - Phone:678-352-1642
Practice Address - Fax:678-352-1642
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist