Provider Demographics
NPI:1699501874
Name:WELCH, DREW NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:NICOLE
Last Name:WELCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 BAILEY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-3149
Mailing Address - Country:US
Mailing Address - Phone:682-243-8640
Mailing Address - Fax:
Practice Address - Street 1:1715 MARTIN DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6738
Practice Address - Country:US
Practice Address - Phone:817-458-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2182854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant