MEDICARE: SUELLEN MACEDO WELLER

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	1305652	TX

General Provider Information

NPI Number	:	1861359184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUELLEN MACEDO WELLER

Provider Business Mailing Address
First Line	:	2975 TERRELL COVE LN
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-1558
Country	:	US
Telephone Number	:	832-641-7026
Fax Number	:

Provider Business Practice Location Address
First Line	:	19400 SPACE CENTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3792
Country	:	US
Telephone Number	:	832-641-7026
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	03/05/2026

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Directions to “ SUELLEN MACEDO WELLER ” Practice Location

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