MEDICARE: CRISTINA NOELLE WELLS PTA, AT

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1720817851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA NOELLE WELLS PTA, AT

Provider Business Mailing Address
First Line	:	10964 TANAGER TRL
Second Line	:
City	:	BRECKSVILLE
State	:	OH
Zip	:	44141-1451
Country	:	US
Telephone Number	:	216-269-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 MEDINA RD
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-8144
Country	:	US
Telephone Number	:	330-225-4182
Fax Number	:

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

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	07/29/2024

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