Provider Demographics
NPI:1770640419
Name:WELLS, STEPHEN E (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:WELLS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W REGINA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1947
Mailing Address - Country:US
Mailing Address - Phone:509-444-8383
Mailing Address - Fax:509-444-8385
Practice Address - Street 1:1605 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2620
Practice Address - Country:US
Practice Address - Phone:509-444-8383
Practice Address - Fax:509-444-8385
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022350225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0214519OtherWA STATE LABOR & INDUSTRI