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General NPI Number Information
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NPI Number | 1780767327
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Entity Type | Individual
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Provider Name | BRETT WELLS PT
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 111 MAIN ST
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City | CORNWALL
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State | NY
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Zip | 12518-1530
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Country | US
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Telephone | 845-534-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 154 OLD STATE RD
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City | HIGHLAND FALLS
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State | NY
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Zip | 10928-4303
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Country | US
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Telephone | 845-325-9826
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0260001
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 026000
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License Number State | NY
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