Provider Demographics
NPI:1508212705
Name:WELCH, MICHAEL (MS, ATC/L, CSCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:MS, ATC/L, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 JOHN ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-1823
Practice Address - Country:US
Practice Address - Phone:617-521-1035
Practice Address - Fax:617-521-1026
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1923174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist