Provider Demographics
NPI:1215222146
Name:WELCH, SANDRA SMITH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SMITH
Last Name:WELCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3620
Mailing Address - Country:US
Mailing Address - Phone:225-304-3270
Mailing Address - Fax:
Practice Address - Street 1:3549 NELSON ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3620
Practice Address - Country:US
Practice Address - Phone:225-304-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA5111225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist