Provider Demographics
NPI:1821392689
Name:WELLS, SARAH NICOLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:NICOLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:NICOLE
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3001 HIGHWAY 121
Mailing Address - Street 2:UNIT 292
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039
Mailing Address - Country:US
Mailing Address - Phone:817-684-0397
Mailing Address - Fax:817-684-8253
Practice Address - Street 1:3001 HIGHWAY 121
Practice Address - Street 2:UNIT 292
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039
Practice Address - Country:US
Practice Address - Phone:817-684-0397
Practice Address - Fax:817-684-8253
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1202549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist