Provider Demographics
NPI:1417556333
Name:WUELLNER, PHILIP H (DPT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:H
Last Name:WUELLNER
Suffix:
Gender:M
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:AQILUS HEALTH, INC.
Mailing Address - Street 2:1305 TEXAS AVENUE
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71305
Mailing Address - Country:US
Mailing Address - Phone:318-443-5278
Mailing Address - Fax:318-443-1906
Practice Address - Street 1:AQILUS HEALTH, INC.
Practice Address - Street 2:1305 TEXAS AVENUE
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71305
Practice Address - Country:US
Practice Address - Phone:318-443-5278
Practice Address - Fax:318-443-1906
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist