Provider Demographics
NPI:1689091019
Name:WELLS, JAMES WEBB (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WEBB
Last Name:WELLS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3049
Mailing Address - Country:US
Mailing Address - Phone:334-673-2422
Mailing Address - Fax:
Practice Address - Street 1:3118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3049
Practice Address - Country:US
Practice Address - Phone:334-673-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3166261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy