Healthcare Provider Details

I. General information

NPI: 1710606686
Provider Name (Legal Business Name): CHARLISA WELLINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MOBILE HWY
MONTGOMERY AL
36108-4027
US

IV. Provider business mailing address

3060 MOBILE HWY
MONTGOMERY AL
36108-4027
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-6502
  • Fax: 334-293-6474
Mailing address:
  • Phone: 334-293-6502
  • Fax: 334-293-6474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP056520T
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: