Provider Demographics
NPI:1407390701
Name:WELCH, KATHRYN SHUSTEK (ATC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SHUSTEK
Last Name:WELCH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0555
Mailing Address - Country:US
Mailing Address - Phone:619-370-7885
Mailing Address - Fax:
Practice Address - Street 1:7323 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0555
Practice Address - Country:US
Practice Address - Phone:619-370-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer