Provider Demographics
NPI:1912987991
Name:WELCH, EDWARD LEE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LEE
Last Name:WELCH
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W DUBOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3905
Mailing Address - Country:US
Mailing Address - Phone:814-375-6830
Mailing Address - Fax:814-375-6832
Practice Address - Street 1:602 W DUBOIS AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3905
Practice Address - Country:US
Practice Address - Phone:814-375-6830
Practice Address - Fax:814-375-6832
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008866L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023200KPYMedicare ID - Type UnspecifiedPHYSICAL THERAPIST