Provider Demographics
NPI:1649250911
Name:WELLEN, MICHELLE A (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:WELLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTOR
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-856-9510
Mailing Address - Fax:508-853-1907
Practice Address - Street 1:135 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:508-856-9510
Practice Address - Fax:508-853-1907
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherHEALTHCARE VALUE MANAGMEN
042472266OtherPRIVATE HEALTHCARE SYSTEM
Y67939OtherBLUE CARE ELECT
35481155OtherCIGNA HEALTHSOURCE
787405OtherMVP HEALTH CARE
Y67939OtherBLUE SHIELD INDEMNITY
042472266OtherONE HEALTH PLAN
44341OtherFALLON COMMUNITY HEALTH P
AA4052OtherHARVARD PILGRIM HEALTHCAR
0319180OtherMEDICAID/WELFARE
2779432001OtherCIGNA PAL ID (REFERRAL #)
650017525OtherRAILROAD MEDICARE
7714608OtherAETNA/US HEALTHCARE
Y68479OtherMEDICARE B
MA0319180Medicaid
2779432OtherCIGNA HEALTH PLAN
Y67939OtherBLUE SHIELD HMO BLUE
042472266OtherTHREE RIVERS
Y67939OtherBLUE SHIELD INDEMNITY