Individual
TIMOTHY WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC.
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46808
(201) 661-0666
Mailing address
3946 ICE WAY, FORT WAYNE, IN 46808
(201) 661-0666
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002698A
IN
Other
Enumeration date
03/05/2018
Last updated
03/05/2018
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