Individual
KIMBERLY MARIE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
850 BAXTER BLVD, PORTLAND, ME 04103-4901
(207) 774-7878
(207) 879-6201
Mailing address
19 HOMESTEAD DR, LYMAN, ME 04002-7565
(203) 430-3557
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4399
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT4399
MAINE STATE LICENSING BOARD
ME
Enumeration date
03/22/2018
Last updated
03/22/2018
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