Provider Demographics
NPI:1134306889
Name:WELCH, LAUREL JEAN (PT, HPCS)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:JEAN
Last Name:WELCH
Suffix:
Gender:F
Credentials:PT, HPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 WALLUM LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516
Mailing Address - Country:US
Mailing Address - Phone:508-476-3966
Mailing Address - Fax:
Practice Address - Street 1:55 SUMMER STREET
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769
Practice Address - Country:US
Practice Address - Phone:508-252-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4053225100000X
RIPT00723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist