Healthcare Provider Details

I. General information

NPI: 1750621520
Provider Name (Legal Business Name): TESSA M WELLS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 31ST ST SUITE 104
KEARNEY NE
68847-2926
US

IV. Provider business mailing address

10 E 31ST ST SUITE 104
KEARNEY NE
68847-2926
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-7182
  • Fax: 308-865-2881
Mailing address:
  • Phone: 308-865-7182
  • Fax: 308-865-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2483
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: