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General NPI Number Information
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NPI Number | 1972543411
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Entity Type | Individual
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Provider Name | BRENT LANE WELLS P.T.,D.P.T., O.C.S
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 34910 IH 10 W SUITE 401
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City | BOERNE
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State | TX
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Zip | 78006-9229
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Country | US
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Telephone | 830-816-2611
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Fax | 830-816-2688
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Provider Business Mailing Address
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Address Line | PO BOX 1468
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City | BOERNE
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State | TX
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Zip | 78006-1468
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Country | US
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Telephone | 830-816-2611
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Fax | 830-816-2688
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1125367
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License Number State | TX
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