Provider Demographics
NPI:1437734860
Name:WELLS, DAWN ALICIA (MFP-C)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:ALICIA
Last Name:WELLS
Suffix:
Gender:F
Credentials:MFP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 FORT BELVOIR DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5278 HIGHWAY 20 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4438
Practice Address - Country:US
Practice Address - Phone:312-659-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
99696081224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Single Specialty