Active NPI
Mary Ellen Wells, PT
- Physical Therapist
- Santa Rosa, CA
National Provider Identifier
1760607469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT22023
- Practice address
- 5555 Montgomery Drive
Spring Lake Village
Santa Rosa, CA 95409 - Phone
- (707) 579-6972
- NPI assigned
- Apr 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT22023 | CA | Primary |
Addresses
Primary practice location
5555 Montgomery Drive
Spring Lake Village
Santa Rosa, CA 95409
Mailing address
4560 SE International Way Suite 100
Consonus Healthcare Services
Milwaukie, OR 97222
Phone (971) 206-5129
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT22023 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sebastopol Physical Therapy and Pilates Studio | Physical Therapist | Past | Accepting new patients |
| Rujju Consultants LLC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Geriatric Medicine (Internal Medicine) Physician
- Santa Rosa, CA
- NPI 1902497266
-
- Physical Therapist
- Sebastopol, CA
- NPI 1538201546
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760607469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY SUITE 100",
"address_2": "CONSONUS HEALTHCARE SERVICES",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "97222",
"telephone_number": "971-206-5129",
"fax_number": "971-206-5209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5555 MONTGOMERY DRIVE",
"address_2": "SPRING LAKE VILLAGE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "95409",
"telephone_number": "707-579-6972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "MARY ELLEN",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT22023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.