Individual
KENNETH A WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ORT
Contact information
Practice address
3334 CAPITAL MEDICAL BLVD, STE 100, TALLAHASSEE, FL 32308-4470
(850) 877-8174
(850) 877-5636
Mailing address
3334 CAPITAL MEDICAL BLVD, STE 400, TALLAHASSEE, FL 32308-8405
(850) 877-8174
(850) 877-5636
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
000066
GA
222Z00000X
Orthotist
Primary
ORT44
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409058070A
—
GA
Enumeration date
05/27/2005
Last updated
06/22/2011
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