Provider Demographics
NPI:1134655251
Name:WELBORN, TODD BENJAMIN (PTA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:BENJAMIN
Last Name:WELBORN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3405 NW HUNTERS RIDGE TER
Practice Address - Street 2:STE 300
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2509
Practice Address - Country:US
Practice Address - Phone:785-246-2300
Practice Address - Fax:785-246-2301
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03190225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant