Healthcare Provider Details

I. General information

NPI: 1780924159
Provider Name (Legal Business Name): WELLS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15569 VALLECAS LN
NAPLES FL
34110-2829
US

IV. Provider business mailing address

15569 VALLECAS LN
NAPLES FL
34110-2829
US

V. Phone/Fax

Practice location:
  • Phone: 904-568-1156
  • Fax:
Mailing address:
  • Phone: 904-568-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN M WELLS
Title or Position: OWNER AND PT
Credential: DPT, PT, OCS, ATC
Phone: 904-568-1156