Provider Demographics
NPI:1508807991
Name:WELLMAN, GREGORY T (DPT)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:WELLMAN
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 1:1027 REGENTS BLVD
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6030
Mailing Address - Country:US
Mailing Address - Phone:253-720-5630
Mailing Address - Fax:
Practice Address - Street 1:1027 REGENTS BLVD
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6030
Practice Address - Country:US
Practice Address - Phone:253-720-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1440WEOtherREGENCE BLUESHIELD
WA8371098Medicaid
WA8930587OtherL&I CRIME VICTIMS PROGRAM
WA174404OtherLABOR & INDUSTRIES
WA174404OtherLABOR & INDUSTRIES