Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT001951 | GA |
NPI | 1003088287 |
---|---|
Provider Name | Mrs. Patricia G Wells |
First Address | Copperhill, TN 37317-5006 |
Second Address | Moultrie, GA 31768-6524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2008 |
Last Update Date | 30/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
549828101A | (05) | GA |