Healthcare Provider Details

I. General information

NPI: 1053244715
Provider Name (Legal Business Name): ISAIAH WELLS I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 WALLI STRASSE DR
BURTON MI
48509-1729
US

IV. Provider business mailing address

1492 LAKE NEPESSING RD
LAPEER MI
48446-2927
US

V. Phone/Fax

Practice location:
  • Phone: 810-715-7746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: