Provider Demographics
NPI:1043331051
Name:WELSH III, RICHARD H (DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:WELSH III
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POMPERAUG OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2288
Mailing Address - Country:US
Mailing Address - Phone:203-264-1735
Mailing Address - Fax:203-264-9251
Practice Address - Street 1:2 POMPERAUG OFFICE PARK
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2288
Practice Address - Country:US
Practice Address - Phone:203-264-1735
Practice Address - Fax:203-264-9251
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004398203Medicaid
CTANC1153OtherOXFORD HEALTH PLAN
CTOV1301OtherHEALTHNET
CT080002440CT01OtherBLUE CROSS
CT061360137OtherTIN