Provider Demographics
NPI:1619912383
Name:WELLS PHYSICAL THERAPY OF BOERNE, P.L.L.C.
Entity Type:Organization
Organization Name:WELLS PHYSICAL THERAPY OF BOERNE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:830-816-2611
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1468
Mailing Address - Country:US
Mailing Address - Phone:830-816-2611
Mailing Address - Fax:830-816-2688
Practice Address - Street 1:34910 IH 10 W
Practice Address - Street 2:SUITE 401
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9229
Practice Address - Country:US
Practice Address - Phone:830-816-2611
Practice Address - Fax:830-816-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179987601Medicaid
TX00472XMedicare ID - Type UnspecifiedMEDICARE GROUP #
TX179987601Medicaid