MEDICARE: DR. ALICIA ANDREA WELLS PT, DPT

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
1	225100000X	Physical Therapist	4213	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386809747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA ANDREA WELLS PT, DPT

Provider Business Mailing Address
First Line	:	2951 HYDER AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2938
Country	:	US
Telephone Number	:	720-280-0710
Fax Number	:

Provider Business Practice Location Address
First Line	:	5006 COPPER AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-1301
Country	:	US
Telephone Number	:	505-268-7988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	10/03/2012

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