Healthcare Provider Details

I. General information

NPI: 1871407379
Provider Name (Legal Business Name): FONETIA WELLS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E 3RD ST
THE DALLES OR
97058-2508
US

IV. Provider business mailing address

10154 RIDGETOP RD
DUFUR OR
97021-3115
US

V. Phone/Fax

Practice location:
  • Phone: 541-705-5489
  • Fax:
Mailing address:
  • Phone: 541-705-5489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29958
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: