Individual
STACEE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
19945 SW BOONES FERRY RD, TUALATIN, OR 97062-7272
(503) 612-5400
Mailing address
2420 NE LYNDA LN, BEND, OR 97701-5872
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09192
OR
Other
Enumeration date
06/15/2015
Last updated
06/15/2015
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