Provider Demographics
NPI:1538504758
Name:WELCH, BRIAN EDWARD (MED, ATC, LAT, PTA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EDWARD
Last Name:WELCH
Suffix:
Gender:M
Credentials:MED, ATC, LAT, PTA
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Mailing Address - Street 1:136 TEAGUE SPECIAL EVENTS CTR
Mailing Address - Street 2:ACU BOX 27916
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79699-7916
Mailing Address - Country:US
Mailing Address - Phone:325-674-2506
Mailing Address - Fax:325-674-4822
Practice Address - Street 1:136 TEAGUE SPECIAL EVENTS CTR
Practice Address - Street 2:ACU BOX 27916
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79699-7916
Practice Address - Country:US
Practice Address - Phone:325-674-2506
Practice Address - Fax:325-674-4822
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2014-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2008003318225200000X
TXAT50812255A2300X
MO20110080242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant