Provider Demographics
NPI:1194913376
Name:WELLMAN, JEFFREY S (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:WELLMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17166 POST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16404-4030
Mailing Address - Country:US
Mailing Address - Phone:814-763-2445
Mailing Address - Fax:814-763-5698
Practice Address - Street 1:5500 BROOKTREE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9260
Practice Address - Country:US
Practice Address - Phone:724-940-3468
Practice Address - Fax:724-940-3969
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTOOO6296L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist