Individual provider Active NPI

Lisa Marie Wells, P.T.

  • Physical Therapist
  • Greenville, SC
National Provider Identifier
1164763785
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5257 Issued in SC
Practice address
201 Roper Creek Dr
Greenville, SC 29615-6927
Phone
(864) 286-9966
NPI assigned
Mar 6, 2013
Last updated
Nov 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5257 SC Primary

Addresses

Primary practice location

201 Roper Creek Dr
Greenville, SC 29615-6927

Mailing address

PO Box 749303
Atlanta, GA 30374-9303
Phone (864) 573-5075

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130628000423 SC Practitioner - Physical Therapist in Private Practice 6507006376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Oakland College of Medicine and Surgery, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Physical Therapy LLCGroup PAC ID 2769915347, 25 clinicians

Practice addresses (Care Compare)

1762 E Main St
Spartanburg, SC 29307-2231
Phone (864) 573-5075

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5257SCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Physical Therapy LLC Physical Therapist CurrentSince Nov 1, 2024 Accepting new patients
Upper Extremity Rehab Specialists, PA Physical Therapist CurrentSince Mar 4, 2013 Accepting new patients

Locations

201 Roper Creek Dr
Greenville, SC 29615
Phone (864) 286-9966

1510 Ribaut Rd
Port Royal, SC 29935
Phone (843) 524-3241

1762 E Main St
Spartanburg, SC 29307
Phone (864) 573-5075

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1164763785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749303",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749303",
            "telephone_number": "864-573-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 ROPER CREEK DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156927",
            "telephone_number": "864-286-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-06",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.