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NPI Code Detail

MEDICARE: MRS. PATRICIA RAQUEL WELLS PTA

MEDICARE: MRS. PATRICIA RAQUEL WELLS PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2311SC

General Provider Information

NPI Number : 1023256799
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PATRICIA RAQUEL WELLS PTA
Provider Business Mailing Address
First Line : 401 N MAIN ST
Second Line : SUITE B
City : HEMINGWAY
State : SC
Zip : 29554-9191
Country : US
Telephone Number : 843-558-4830
Fax Number : 843-558-7752
Provider Business Practice Location Address
First Line : 401 N MAIN ST
Second Line : SUITE B
City : HEMINGWAY
State : SC
Zip : 29554-9191
Country : US
Telephone Number : 843-558-4830
Fax Number : 843-558-7752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2009
Last Update Date : 02/03/2009

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