Provider Demographics
NPI:1912666884
Name:WELLS, MARTI (LMT)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14819 N CAVE CREEK RD STE 16B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5034
Mailing Address - Country:US
Mailing Address - Phone:480-453-5759
Mailing Address - Fax:
Practice Address - Street 1:14819 N CAVE CREEK RD # 16B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4909
Practice Address - Country:US
Practice Address - Phone:480-453-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-25339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist