Provider Demographics
NPI:1811951320
Name:WELLS, CAROL A (PT)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 WALNUT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-2665
Mailing Address - Country:US
Mailing Address - Phone:307-322-1878
Mailing Address - Fax:307-322-1879
Practice Address - Street 1:953 WALNUT ST
Practice Address - Street 2:SUITE A
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-2665
Practice Address - Country:US
Practice Address - Phone:307-322-1878
Practice Address - Fax:307-322-1879
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308208Medicare ID - Type Unspecified