Provider Demographics
NPI:1457454639
Name:WELLING, LORRAINE FRANCES (PT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:FRANCES
Last Name:WELLING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:FRANCIS
Other - Last Name:SCHEIDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:116 E BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8101
Mailing Address - Country:US
Mailing Address - Phone:813-655-3342
Mailing Address - Fax:813-653-0894
Practice Address - Street 1:116 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8101
Practice Address - Country:US
Practice Address - Phone:813-655-3342
Practice Address - Fax:813-653-0894
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 2513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY908VOtherBLUE CROSS/BLUE SHIELD
U48632Medicare ID - Type Unspecified