Provider Demographics
NPI:1124240528
Name:WELCH, AMY NICHOLS (PT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NICHOLS
Last Name:WELCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 GLEN RANCH DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6310
Mailing Address - Country:US
Mailing Address - Phone:817-447-9318
Mailing Address - Fax:
Practice Address - Street 1:407 OLD SPRINGTOWN RD
Practice Address - Street 2:114
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-2773
Practice Address - Country:US
Practice Address - Phone:817-220-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1123487174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist