Provider Demographics
NPI:1831364074
Name:WELLS, SANDRA JEAN (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
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 1:1603 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6112
Mailing Address - Country:US
Mailing Address - Phone:518-370-0265
Mailing Address - Fax:518-377-5777
Practice Address - Street 1:1603 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6112
Practice Address - Country:US
Practice Address - Phone:518-370-0265
Practice Address - Fax:518-377-5777
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB7895Medicare PIN