Provider Demographics
NPI:1861039521
Name:WELLS, ALLIE ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:ELIZABETH
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1233
Mailing Address - Country:US
Mailing Address - Phone:518-481-2440
Mailing Address - Fax:518-481-2617
Practice Address - Street 1:187 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1233
Practice Address - Country:US
Practice Address - Phone:518-481-2440
Practice Address - Fax:518-481-2617
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044591-012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic