Provider Demographics
NPI:1770124737
Name:WELLS, MARTHA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
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 1:19 BACK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:NH
Mailing Address - Zip Code:03592-5402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-2000
Practice Address - Country:US
Practice Address - Phone:603-237-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist