Provider Demographics
NPI:1962737718
Name:WELLS, LINDA (MED, RMT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MED, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 MAIN ST
Mailing Address - Street 2:O-201
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8118
Mailing Address - Country:US
Mailing Address - Phone:970-471-0041
Mailing Address - Fax:
Practice Address - Street 1:137 MAIN ST
Practice Address - Street 2:O-201
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-8118
Practice Address - Country:US
Practice Address - Phone:970-471-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist