Provider Demographics
NPI:1386809747
Name:WELLS, ALICIA ANDREA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANDREA
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 HYDER AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2938
Mailing Address - Country:US
Mailing Address - Phone:720-280-0710
Mailing Address - Fax:
Practice Address - Street 1:5006 COPPER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1301
Practice Address - Country:US
Practice Address - Phone:505-268-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17900328Medicaid
COC301339Medicare PIN