Healthcare Provider Details

I. General information

NPI: 1114097805
Provider Name (Legal Business Name): JANIS A WELLS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 DANA DR
NEW WAVERLY TX
77358
US

IV. Provider business mailing address

30 DANA DR
NEW WAVERLY TX
77358
US

V. Phone/Fax

Practice location:
  • Phone: 979-285-5571
  • Fax: 844-364-2660
Mailing address:
  • Phone: 979-285-5571
  • Fax: 844-364-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1003994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: