Individual
MRS. TRACY LYNN WELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1331 5TH AVE., DEWITT, IA 52742
(563) 340-9161
Mailing address
1331 5TH AVE., DEWITT, IA 52742
(563) 340-9161
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
00333
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00333
IA STATE LICENSE
IA
Enumeration date
03/13/2014
Last updated
03/13/2014
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