MEDICARE: MRS. MELANIE MARIE WELLS PT

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
1	225100000X	Physical Therapist	5501011231	MI

General Provider Information

NPI Number	:	1992921647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE MARIE WELLS PT

Provider Business Mailing Address
First Line	:	28984 FOREST HILL DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-2439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28984 FOREST HILL DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-2439
Country	:	US
Telephone Number	:	248-919-8723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	04/28/2022

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