Healthcare Provider Details

I. General information

NPI: 1891134581
Provider Name (Legal Business Name): BRADLEY SCOTT WELLS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 US-98
PENSACOLA FL
32512-1098
US

IV. Provider business mailing address

9539 LORIKEET LN
PENSACOLA FL
32507-7229
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6601
  • Fax:
Mailing address:
  • Phone: 912-484-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number6374
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: