Provider Demographics
NPI:1265790513
Name:WELLS, REED (ATP)
Entity type:Individual
Prefix:MR
First Name:REED
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2514
Mailing Address - Country:US
Mailing Address - Phone:806-351-2500
Mailing Address - Fax:
Practice Address - Street 1:2112 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2514
Practice Address - Country:US
Practice Address - Phone:806-351-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP47963225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189016208Medicaid
TX189016207Medicaid