Healthcare Provider Details

I. General information

NPI: 1588570113
Provider Name (Legal Business Name): ANDREW WELLS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E JOPPA RD STE 402
TOWSON MD
21286-3109
US

IV. Provider business mailing address

200 E JOPPA RD STE 402
TOWSON MD
21286-3109
US

V. Phone/Fax

Practice location:
  • Phone: 410-870-4136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM06296
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: