Provider Demographics
NPI:1013744812
Name:WELLS, ASHLEY AGUILLARD (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AGUILLARD
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 1:40328 OLD HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6755
Mailing Address - Country:US
Mailing Address - Phone:225-287-2712
Mailing Address - Fax:
Practice Address - Street 1:13025 HIGHWAY 44 STE 101-103
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6855
Practice Address - Country:US
Practice Address - Phone:225-726-2460
Practice Address - Fax:225-726-2461
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist