Provider Demographics
NPI:1821804139
Name:WELLS, CHRISTIAN ANDREW (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ANDREW
Last Name:WELLS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19558 ROUTE V64
Mailing Address - Street 2:
Mailing Address - City:DOUDS
Mailing Address - State:IA
Mailing Address - Zip Code:52551-8193
Mailing Address - Country:US
Mailing Address - Phone:641-919-5960
Mailing Address - Fax:
Practice Address - Street 1:402 W BURLINGTON AVE # 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3243
Practice Address - Country:US
Practice Address - Phone:641-469-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125024225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant