Provider Demographics
NPI:1306253158
Name:WELLS, GAIL ANN
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ANN
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NORMANSKILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1331
Mailing Address - Country:US
Mailing Address - Phone:518-475-9456
Mailing Address - Fax:
Practice Address - Street 1:2 NORMANSKILL BLVD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1331
Practice Address - Country:US
Practice Address - Phone:518-475-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3408225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY921399OtherWORKERS COMP AND NO-FAULT