Provider Demographics
NPI:1720817851
Name:WELLS, CRISTINA NOELLE (PTA, AT)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:NOELLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:PTA, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10964 TANAGER TRL
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1451
Mailing Address - Country:US
Mailing Address - Phone:216-269-0706
Mailing Address - Fax:
Practice Address - Street 1:2508 MEDINA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8144
Practice Address - Country:US
Practice Address - Phone:330-225-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant