Provider Demographics
NPI:1558607929
Name:WELLMAN, KRIS CHILSON (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:CHILSON
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 1:3290 RATTLE RUN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-4714
Mailing Address - Country:US
Mailing Address - Phone:248-309-2272
Mailing Address - Fax:
Practice Address - Street 1:3290 RATTLE RUN RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-4714
Practice Address - Country:US
Practice Address - Phone:248-309-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist