Provider Demographics
NPI:1245393248
Name:WELSH, AMY W (MSPT, OCS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:W
Last Name:WELSH
Suffix:
Gender:F
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EASTLAND BLVD
Mailing Address - Street 2:SUITE 3B MEDICAL BLDG G
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4104
Mailing Address - Country:US
Mailing Address - Phone:727-797-7600
Mailing Address - Fax:727-797-7655
Practice Address - Street 1:3001 EASTLAND BLVD
Practice Address - Street 2:SUITE 3B MEDICAL BLDG G
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4104
Practice Address - Country:US
Practice Address - Phone:727-797-7600
Practice Address - Fax:727-797-7655
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5958OtherBCBS
FLY5958ZMedicare PIN