Individual
MR. BRENT LANE WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.,D.P.T., O.C.S
Contact information
Practice address
34910 IH 10 W, SUITE 401, BOERNE, TX 78006-9229
(830) 816-2611
(830) 816-2688
Mailing address
PO BOX 1468, BOERNE, TX 78006-1468
(830) 816-2611
(830) 816-2688
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1125367
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00472X
MEDICARE GROUP UPIN
TX
01
—
0084LJ
BCBS GROUP
TX
01
—
8T2859
BCBS PROVIDER
TX
Enumeration date
06/06/2006
Last updated
11/01/2007
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