Provider Demographics
NPI:1013115260
Name:WELLS, AARON (PT, MPT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S INTERSTATE 35
Mailing Address - Street 2:STE 203
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4126
Mailing Address - Country:US
Mailing Address - Phone:512-863-7761
Mailing Address - Fax:512-863-0973
Practice Address - Street 1:1700 E PALM VALLEY BLVD
Practice Address - Street 2:STE 395
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4677
Practice Address - Country:US
Practice Address - Phone:512-354-4067
Practice Address - Fax:512-354-4068
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1202073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18708OtherBGFH
KY1013115260OtherTRICARE
KY528714OtherANTHEM
KY1232641OtherCHA
KY1013115260OtherTRICARE