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General NPI Number Information
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NPI Number | 1841140654
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Entity Type | Individual
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Provider Name | MARK WELLER
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Gender | Male
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 01/31/2026
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Provider Practice Location Address
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Address Line | 944 REGAL RD
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City | ENCINITAS
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State | CA
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Zip | 92024-4634
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Country | US
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Telephone | 760-944-0331
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Fax |
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Provider Business Mailing Address
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Address Line | 2316 PASEO DE LAURA APT 217
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City | OCEANSIDE
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State | CA
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Zip | 92056-3748
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Country | US
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Telephone | 442-404-7819
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 299530
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License Number State | CA
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