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NPI Code Detail

MEDICARE: LEAH WELLER

MEDICARE: LEAH WELLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10600MN

General Provider Information

NPI Number : 1578930509
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH WELLER
Provider Business Mailing Address
First Line : 3835 SUPREME CT NW STE 2
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-4485
Country : US
Telephone Number : 218-444-8280
Fax Number : 218-444-8337
Provider Business Practice Location Address
First Line : 3835 SUPREME CT NW STE 2
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-4485
Country : US
Telephone Number : 218-444-8280
Fax Number : 218-444-8337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2015
Last Update Date : 11/20/2017

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Directions to “ LEAH WELLER ” Practice Location

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