Doctor Name: | MR. KENNETH ALAN WELLS |
NPI Number: | 1659550051 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.MT. |
License Number: | 10956 |
Business Practice Address: | 14780 Sw Osprey Dr Suite 350 Beaverton, OR - 970078028 |
Business Phone Number: | 5037081082 |
Business Fax Number: | |
Mailing Address: | 14780 Sw Osprey Dr, Suite 350 BEAVERTON |
State: | OR |
Postal Code: | 970078028 |
Phone Number: | 5037081082 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2007 |
NPI Last Update Date: | 11/01/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 10956 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |