Amanda Lee Wellman, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501021613 Issued in MI

Practice address

12319 Highland Rd Ste 501
Hartland, MI 48353-2946

Phone

(810) 991-1211

NPI assigned

Dec 22, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda Lee Blok Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Ivyrehab Northern PT, LLC

  • Physical Therapy Clinic/Center
  • Sparta, MI
  • NPI 1972592525
  NPD (past)

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

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1972263572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 419885",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022419885",
            "telephone_number": "888-830-4125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12319 HIGHLAND RD STE 501",
            "city": "HARTLAND",
            "state": "MI",
            "postal_code": "483532946",
            "telephone_number": "810-991-1211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Rounds Dr",
            "address_purpose": "LOCATION",
            "city": "Fenton",
            "state": "MI",
            "postal_code": "484301724",
            "country_code": "US",
            "telephone_number": "810-629-0530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WELLMAN",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-22",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501021613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "BLOK",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Margie Kay Walker, RN
• Taroshaka Walker
• Zohra Wardak, FNP-BC
• Hailey Renea Weiss
• Danielle Maria Welbon, MA
• Wellness 4 Life Chiropractic PLLC
• Deshari Whiteside
• Annette Renee Wilder
• Michael R Wolfgram, DDS
• Austin Wolford

• Physical Therapist in Hartland, MI
• Providers in Hartland, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.